refers to treatment of the fracture/dislocation without a surgical incision into the site. --specifically means that the fracture site is not surgically opened (exposed to the external environment and directly visualized). This terminology is used to describe procedures that treat fractures by three methods: (1) without manipulation; (2) with manipulation;
(3)with or without traction
refers to the treatment of a fracture or dislocation that includes exposing the site via a surgical incision or when a fractured bone is opened remote from the fracture site in order to insert an intramedullary nail across the fracture site -- used when the fractured bone is either: (1) surgically opened (exposed to the external environment) and the fracture (bone ends) visualized and internal fixation may be used; or
(2) the fractured bone is opened remote fromthe fracture site in order to insert an intramedullar nail across the fracture site (the fracture site is not opened and visualized).
PERCUTANEOUS SKELETAL FIXATION
involves treatment of a fracture by placing fixation devices such as pins across the fracture site, usually under x-ray imaging.
The type of fracture (eg., open compound, closed)
does not have any coding correlation with the type of treatment (eg., closed, open, or percutaneous) provided
The codes for treatment of fractures and joint injuries (dislocations)
are categorized by the type of manipulation (reduction) and stavilization (fixation or immobilization). These codes can apply to either open (compound) or closed fractures or joint injuries.
is the application of a force (distracting or traction force) to a limb segment through a wire, pin, screw, or clamp that is (eg.,penetrate) to bone.
is the application of a force (longitudinal) to a limb using felt or strapping applied directly to skin only.
Codes for obtaining autogenous bone grafts, cartilage, tendon, fascia lata grafts or other issues through separate incisions
are to be used only when the graft is not already listed as part of the basic procedure.
Re-reduction of a fracture and/or dislocation performed by the primary physician
may be identified by the addition of the modifier 76 to the usual procedure number to indicate "Repeat Procedure or Service by Same Physician." (See Appendix A guidelines.)
refers to the attempted reduction or restoration of a dislocated joint or fracture. -- is used throughout the musculoskeletal fracture and dislocation subsections to specifically mean the attempted reduction or restoration of a fracture or joint dislocation to its normal anatomic alignment by the application of manually applied forces. CPT codes are available for reporting nondiplaced fractures treated without manipulation.
EXCISION OF SUBCUTANEOUS SOFT TISSUE TUMORS (including simple or intermediate repair)
involves the simple or marginal resection of tumors confined to subcutaneous tissue below the skin but above the deep fascia. Code selection is based on the location and size of the tumor. Code selection is determined by measuring the greatest diameter of the tumor plus that margin required for complete excision of the tumor.
EXCISION OF FASCIAL OR SUBFASCIAL SOFT TISSUE TUMORS (including simple or intermediate repair)
involves the resection of tumors confined to the tissue within or below the deep fascia, but not involving the bone.
Application of casts and strapping can be reported in the following scenarios:
1. to identify replacemtne of a cast or stapping dutin or after the period of normal follow-up care (global postoperative period)
2. to identify an initial service performed without any restorative treatment or stabilization of the fracture, injury, or dislocation and/or to afford pain relief to the patient
3. to identify an initial cast or strapping when the same physician does not perform, or is not expected to perform, any other treatment or procedure
4. to identify an initial cast or strapping when another physician provided or will provide restorative treatment
CPT guidelines for hospital outpatient reporting of castin/strapping/splinting
can be found in CPT Assistant
Procedures describing both diagnostic and therapeutic arthroscopy are reported with codes 29800 through 29909
These codes are categorized first by body part involved and then by type--- surgical or diagnostic. The surgical arthroscopic codes are further divided to identify the specific procedure performed. A surgical arthroscopy always includes a diagnostic omponent that should not be reported separately.
is cateforized first by body part and then by general type of procedure, with the individual codes describing the specific procedure performed.
If the physician documents an incision of an abscess that extends beyond the skin into the soft tissues (muscle, fascia, or tendon)
coding with a musculoskeletal code would be appropriate
To report the diagnosis and treatment of fractures and dislocations accurately, coding professional must answer the following questions:
1. What body site is involved?
2. Was the fracture/dislocation treatment open or closed or with percutaneous skeletal fixation?
3. Was the fracture/disloction manipulated?
4. Did the procedure include internal or external fixation?