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Med 123. Chapter 4.3 Musculoskeletal System Codes 2000-2999. Surgical procedures on bones, tendons, muscles and soft tissues. Also included is casting and strapping. Procedures are listed from head to feet, subheadings for the type of procedure. Subsections include: Incision excision

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Med 123

Med 123

Chapter 4.3

Musculoskeletal System

Codes 2000-2999


Musculoskeletal section reports

  • Surgical procedures on bones, tendons, muscles and soft tissues.

  • Also included is casting and strapping.

  • Procedures are listed from head to feet, subheadings for the type of procedure.

  • Subsections include:

  • Incision excision

  • Introduction/removalrepair

  • Fracture/dislocationarthrodesis

  • amputation

Musculoskeletal Section reports


Guidelines

  • Always double-check the subheading to make sure the code is from the same anatomical site.

  • The extensive notes and definitions before the first code in the subsection should be reviewed before making code selection.

  • Be careful when using modifier 50. Make sure the procedure notes state bilateral.

Guidelines


Wound exploration 20100 20103

  • To code traumatic wounds (like gunshot, stab wound)

  • Codes are based on body area

  • Codes include:

    • Surgical exploration

    • Enlargement of wound

    • Debridement

    • Removal of foreign body

    • Ligation or coagulation of minor vessels

Wound Exploration 20100-20103


Excision including biopsies

  • For biopsy of soft tissue choose your code by:

    • Site, then superficial or deep

  • Muscle biopsies

    • 20200, 20205, 20206

  • Skin biopsies not coded here – see 11100

  • Test your coding skills…

  • Needle or trocar bone biopsies

Excision, Including Biopsies


Code selections are

Code selections are…

20220 or 20225


Code the following

  • What about for:

  • Needle or trocar bone marrowbiopsy?

Code the following


Answer is

Answer is …

38221


Introduction or removal 20500 20697

  • Introduction would be an injection.

  • Removal could be by aspiration (look this up)

  • Code the introduction as one code.

  • Code the medication agent as a HCPCS code beginning usually with J.

  • For Removal of wires, pins, screws, rods, and plates:

    • 20670 is used for removal of superficial hardware.

    • 20680 is used for removal of implantsthat are considered deep. Deep would be below the muscle or within the bone.

Introduction or Removal 20500 – 20697


Fracture and dislocation

  • Fractures are either:

    • Open (requires a incision to be made for treatment)

    • Closed (does not require a incision for treatment)

    • Percutaneous (fracture has a device placed across the fracture fragments through the skin)

Fracture and Dislocation


Manipulation and traction

  • When the terms reduce or reduction are present in the record to describe the treatment of a fracture a code description of manipulation should be used.

  • Manipulation is also used to describe the restoration of a fracture or jiont dislocation to it’s normal anatomical alignment using manual force.

  • Skeletal traction is the application of force to a limb segment through a wire, pin, screw, or clamp is attached to bone.

  • Skin traction is the application of force to a limb using felt or strapping applied directly to the skin only.

Manipulation and Traction


Coding treatment of fractures and dislocations

  • Ask the following questions:

    • What is the site of the fracture or dislocation?

    • Is treatment open or closed?

    • Is manipulation a part of the treatment?

    • Is an internal or external fixation device used?

  • A cast is not an external fixation device

    • See page 90 of the professional edition of the CPT for illustration of external fixation devices.

Coding treatment of fractures and dislocations


Fracture and dislocation1

  • Fracture and dislocation treatment codes include:

    • Application and removal of the initial cast and/or traction device

    • Follow-up care during the global period associated with the fracture or dislocation treatment code

  • It does not include:

    • Plaster or fiberglass supply used to make the cast (See HCPCS Q codes for appropriate code)

    • Care for complications of the fracture or the fracture site, per the rules of the global surgical package

  • Use cast removal codes for removal of casts applied by another physician

Fracture and Dislocation


Code the following1

  • Open treatment, mandibular fracture w/ external fixation.

  • Look up fracture, mandible, open, external fixation in alphabetical index, then verify in numerical tabular.

Code the following…


Answer is1

Answer is…

21454


Code the following2

  • Closed treatment of scapular fracture, without manipulation

  • Look up fracture, scapula, closed, without manipulation in tabular for your code, then verify in numerical.

Code the following…


Answer is2

Answer is …

23570


Repair and reconstruction

  • Primary repair is the first repair performed.

  • Secondary repair is done subsequently.

Repair and Reconstruction


Spinal procedures to code seperately

  • Arthrodesis (fusion) can be coded separately from other definitive procedures

  • Code seperately:

    • Spinal instrumentation

    • Bone grafts

  • Use modifier –51

  • Watch + and  symbols

Spinal Procedures to Code seperately


Bunion repairs and casts and strapping

  • Bunion Repairs:

  • Removal of medial eminence (bump) from first metatarsal head.

  • Can include revision of the metatarsal shaft, metatarsal head or other surrounding structures.

  • Casting and Strapping

  • Casting is used to alleviate pain for the patient

  • Initial casting when no other treatment is necessary

  • Initial casting when another physician will provide restorative treatment

  • Replacement casts are done during follow up care

Bunion Repairs and Casts and Strapping


Arthroscopy

  • Diagnostic arthroscopy (viewing joint by scope) is included in surgical arthroscopy.

  • If both arthroscopyandarthrotomy (open inspection of joint) are done, code both with a –51 modifier

Arthroscopy


Hcpcs codes pages 128 129

  • Orthopedic accessories

    • For example, slings, splints, rib belts, braces, crutches, and wheelchairs

    • Custom designed and fabricated orthoses

    • Cast supplies:

      • A codes, or

      • Q codes by type of case and age of patient

  • See pages 128-129 for more information

HCPCS Codes pages 128-129


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