MUSCULOSKELETAL SYSTEM CODING

• General (20150 – 20251)

• Head (21011 – 21070)
• Neck/Thorax (21550 – 21632)
• Back/Flank (21920 – 21936)
• Spine (22100 – 22116)
• Abdomen (22900 – 22905)
• Shoulder (23065 – 23220)
• Humerus/Elbow (24065 – 24155)
• Forearm/Wrist (25065 – 25240)
• Hand/Fingers (26100 – 26262)
• Pelvis/Hip Joint (27040 – 27080)
• Femur/Knee (27323 – 27365)
• Leg/Ankle Joint (27613 – 27647)
• Foot/Toes (28039 – 28175)
Soft Tissue Tumor Excision
FRACTURE CARE CODING

• When a patient is initially treated for a traumatic fracture, there

are four typical methods of care that an orthopedic physician
may provide:
• Closed treatment without manipulation involves fitting the
patient to appropriate materials for bone stabilization and
weight bearing/non-weight bearing function.
• Closed reduction with manipulation is non-surgical
manipulation of a fractured bone to restore the bone to normal
anatomic alignment.
• Percutaneous fixation involves the placement of a stabilizing
device such as a rod, plate, multiple wires, pins, or screws
across a fractured bone, typically under imaging guidance.
• Open reduction with internal fixation (ORIF) is an incisional
procedure to realign and fixate separated bone fragments.
 Fracture Care Global Package

All fracture treatment codes currently carry a 90 day global period

and are therefore considered a major procedure.

• 90-days global period:

Includes:
• Restorative treatment or procedure
• All postoperative visits
• Initial application of cast or durable medical equipment (DME)
device
Excludes:
• X-rays
• Replacement or subsequent casting and/or durable medical
equipment (DME) device(s)
• ALL supplies provided
 Rules for Fracture Care Coding

Here are some general ground rules for fracture care coding,
whether operative or non-operative:

• Initial fittings of casts, splints, strappings, and other materials

are included in the global service of fracture care.

• ED physicians bills application of cast for temporary casting and

orthopedic surgeon bills for restorative fracture care CPT
codes(Eg: Close treatment/reduction, precutaneous pinning
and ORIF).

• In a hospital setting, the facility bills for fracture stabilizing

materials.
 ARTHROCENTESIS
• SMALL JOINT INJECTIONS CAN BE
CODED FOR IP, MCP AND CMC JOINTS
IN HAND AND IP, MTP AND TMT
JOINTS IN FOOT.

INTERMEDIATE JOINT INJECTIONS CAN

BE CODED FOR
RADIOCARPAL/UNLOCARPAL(WRIST).
 JOINT REPLACEMENT
ARTHROPLASTY
• Partial/Total joint replacement is a
surgical procedure in which parts of an
arthritic or damaged joint are removed
and replaced with a metal, plastic, or
ceramic device called a prosthesis. The
prosthesis is designed to replicate the
movement of a normal, healthy joint.
TOTAL HIP ARTHROPLASTY
28292-Simple Bunionectomy
28292-McBride or Keller
Bunionectomy.
28295-Bunionectomy with proximal
metatarsal osteotomy.
28296-Austin or Chevron
Bunionectomy.
28297-Lapdius Bunionectomy.
28298-Bunionectomy with phalanx
osteotomy(AKIN).
28299-Bunionectomy with Double
Osteotomy.
SPINE
 PERCUTANEOUS
VERTEBROPLASTY
Percutaneous Kyphoplasty
• Vertebroplasty and vertebral augmentation procedures
include, bone biopsy when performed, moderate
sedation, and the imaging guidance necessary to
perform the procedure.

• One primary procedure code is reported with an add-

on code for each additional level to which the
procedure is performed.

Coding Tip:
• Percutaneous vertebral augmentation procedures
(22513-22515) are for the thoracic and lumbar areas
only. If cervical vertebral augmentation is performed,
the unlisted CPT code (22899) should be reported.
SPINAL FUSION(APPROACHES)
ARTHRODESIS(FUSION)
INTERBODY FUSION
INSTRUMENTATION(NONSEGMENTAL)
• SEGMENTAL
SEPARATE PLATE FIXATION
INTEGRATED CAGE
BONE GRAFT
TOTAL DISC ARTHROPLASTY
Arthroscopy
 LIMITED VS EXTENSVIE DEBRIDEMENT
• Debridement, limited, 1 or 2 discrete structures 3 or
more extensive.
• (eg, humeral bone,
• humeral articular cartilage,
• glenoid bone,
• glenoid articular cartilage,
• biceps tendon,
• biceps anchor complex,
• labrum,
• articular capsule,
• articular side of the rotator cuff,
• bursal side of the rotator cuff,
• subacromial bursa,
• foreign body[ies])
Shoulder
KNEE JOINT
KNEE MOSAICPLASTY(OATS)
ANKLE/FOOT BONES
ANKLE LIGAMENTS