Practicum Module 7: 2000 Series Coding Questions and
Answers
Study Tips - -Refer to the Medical manipulation/percutaneous
Terminology/Anatomy Review of this vertebroplasty/percutaneous
Professional Review Guide for key words augmentation/arthrodesis/exploration/spinal
relevant to the musculoskeletal system. instrumentation/other
Review the anatomical illustrations in the front of
the musculoskeletal section of your CPT manual
for identification of specific body/anatomical Spinal Coding Guidelines
areas. Coding Concepts: - -Vertebral segment:
Add additional body/anatomical terms to these single complete vertebral bone with its articular
illustrations as necessary. processes and lamina
Vertebral interspace: non-bony space between
two adjacent vertebral bodies that contains an
General Musculoskeletal Guidelines General intervertebral disc, nucleus pulposus, annulus
Coding Breakdown: - -Anatomical site fibrosus, and two cartilage endplates
(arranged in anatomical order head to toe) 7 cervical vertebrae (neck area) defined as C1-
Procedure approach C7
(incision/excision/repair/revision/fracture/dislocati 12 thoracic vertebrae (thoracic area) defined as
on/arthrodesis/amputation, etc.) T1-T12
Specific site 5 lumbar vertebrae (lower back area) defined as
Specific procedure technique (open/closed, L1-L5
with/without manipulation) 5 sacral vertebrae (sacrum area) defined as S1-
S5
General Musculoskeletal Guidelines
General Coding Concepts: - - Arthrodesis
Fractures/dislocations Coding Breakdown: - -Musculoskeletal
Closed treatment: not surgically opened, may be system
indicated as with/without manipulation or Spine (vertebral column)
with/without traction Arthrodesis
Open treatment: surgically opened or fracture
visualized for repair, also placement of rod to
fixate fracture remote from fracture site Arthrodesis
Percutaneous skeletal fixation: fixation placed Coding Concepts: - -Arthrodesis due to
across fracture site usually with radiological spinal deformities such as kyphosis is assigned
imaging code 22800-22819.
Initial fracture repair: includes cast/splint Arthrodesis other than to spinal deformity is
application assigned codes by approach:
22548-22586: anterior/anterolateral 22590-
22634: posterior, posterolateral/lateral transverse
Spinal Coding Guidelines 22532-22534: lateral extracavitary Excision of
Coding Breakdown: - -Musculoskeletal intervertebral disk may be assigned code
system separately (unless specifically stated otherwise)
Spine (vertebral column) when performed to prepare vertebral surface for
Incision/excision/osteotomy/fracture/dislocation/ bone graft for arthrodesis.
, Practicum Module 7: 2000 Series Coding Questions and
Answers
Watch the need for RT/LT/50 modifiers. Use re- procedure and not separately reportable.
exploration code(s) if the space has been
explored or a definitive procedure has been
performed previously. Right bunionectomy with distal metatarsal
Spinal instrumentation codes may be assigned in osteotomy was performed. a. 28296
addition to procedure (modifier 51 exempt). b. 28291-RT
Segmental instrumentation: fixation at each end c. 28296-RT
and at least one additional bony attachment. d. 28295-RT - -28296-RT
Removal of bunion was performed with
Arthrodesis by anterior interbody approach was metatarsal osteotomy, which codes to 28296.
performed on the right C3-C4 and C4-C5 with Modifier RT is required per CPT guidelines. Code
spinal instrumentation placed at the time of 28291 requiresimplant and code 28295 is
surgery. performed proximally; therefore, neither of these
a. 22551, 22585-51 codes is appropriate.
b. 22551-RT, 22585-51-RT
c. 22845
d. 22845, 22585-RT, 22551-51-RT - - Cast/Splint Application
22845, 22585-RT, 22551-51-RT Coding Breakdown: - -Musculoskeletal
system
Two levels of arthrodesis were performed, Applications of casts and strapping Cast/splints
requiring two procedure codes for this portion of Upper/lower body
the procedure, 22551 and 22585. Spinal
instrumentation is separately reportable with
arthrodesis; therefore, also assign 22845. Assign Cast/Splint Application
the most significant procedure first (22845), Coding Concepts: - -The initial cast is
followd by additional procedures with modifiers included in the global allowance for a definitive
51/RT. Code 22585 does not require modifier 51 surgical procedure, and therefore is not
because add-on (+) procedures should not have separately reportable when billing the initial
modifier 51 appended. surgery.
Cast application is reportable when performed as
the definitive procedure, such as immobilization
Bunions of sprain, or when fracture is to be repaired at a
Coding Breakdown: - -Musculoskeletal later date by another provider/surgeon. Cast
system application is reportable with reapplication during
Foot and toes the global period (with modifier 58) or after the
Repair/revision/reconstruction postoperative period when medically necessary
(not for patient comfort). Most codes require
laterality RT/LT/50.
Bunions
Coding Concepts: - -Capsulotomy,
arthrotomy, neuroplasty, tenotomy, tenolysis, Patient presents to the physician's office a week
excision of bunion, and associated osteophytes following repair of a tibial/fibular fracture. The
at the first MTP joint are integral to the bunion original surgical cast has cracked, and a
Answers
Study Tips - -Refer to the Medical manipulation/percutaneous
Terminology/Anatomy Review of this vertebroplasty/percutaneous
Professional Review Guide for key words augmentation/arthrodesis/exploration/spinal
relevant to the musculoskeletal system. instrumentation/other
Review the anatomical illustrations in the front of
the musculoskeletal section of your CPT manual
for identification of specific body/anatomical Spinal Coding Guidelines
areas. Coding Concepts: - -Vertebral segment:
Add additional body/anatomical terms to these single complete vertebral bone with its articular
illustrations as necessary. processes and lamina
Vertebral interspace: non-bony space between
two adjacent vertebral bodies that contains an
General Musculoskeletal Guidelines General intervertebral disc, nucleus pulposus, annulus
Coding Breakdown: - -Anatomical site fibrosus, and two cartilage endplates
(arranged in anatomical order head to toe) 7 cervical vertebrae (neck area) defined as C1-
Procedure approach C7
(incision/excision/repair/revision/fracture/dislocati 12 thoracic vertebrae (thoracic area) defined as
on/arthrodesis/amputation, etc.) T1-T12
Specific site 5 lumbar vertebrae (lower back area) defined as
Specific procedure technique (open/closed, L1-L5
with/without manipulation) 5 sacral vertebrae (sacrum area) defined as S1-
S5
General Musculoskeletal Guidelines
General Coding Concepts: - - Arthrodesis
Fractures/dislocations Coding Breakdown: - -Musculoskeletal
Closed treatment: not surgically opened, may be system
indicated as with/without manipulation or Spine (vertebral column)
with/without traction Arthrodesis
Open treatment: surgically opened or fracture
visualized for repair, also placement of rod to
fixate fracture remote from fracture site Arthrodesis
Percutaneous skeletal fixation: fixation placed Coding Concepts: - -Arthrodesis due to
across fracture site usually with radiological spinal deformities such as kyphosis is assigned
imaging code 22800-22819.
Initial fracture repair: includes cast/splint Arthrodesis other than to spinal deformity is
application assigned codes by approach:
22548-22586: anterior/anterolateral 22590-
22634: posterior, posterolateral/lateral transverse
Spinal Coding Guidelines 22532-22534: lateral extracavitary Excision of
Coding Breakdown: - -Musculoskeletal intervertebral disk may be assigned code
system separately (unless specifically stated otherwise)
Spine (vertebral column) when performed to prepare vertebral surface for
Incision/excision/osteotomy/fracture/dislocation/ bone graft for arthrodesis.
, Practicum Module 7: 2000 Series Coding Questions and
Answers
Watch the need for RT/LT/50 modifiers. Use re- procedure and not separately reportable.
exploration code(s) if the space has been
explored or a definitive procedure has been
performed previously. Right bunionectomy with distal metatarsal
Spinal instrumentation codes may be assigned in osteotomy was performed. a. 28296
addition to procedure (modifier 51 exempt). b. 28291-RT
Segmental instrumentation: fixation at each end c. 28296-RT
and at least one additional bony attachment. d. 28295-RT - -28296-RT
Removal of bunion was performed with
Arthrodesis by anterior interbody approach was metatarsal osteotomy, which codes to 28296.
performed on the right C3-C4 and C4-C5 with Modifier RT is required per CPT guidelines. Code
spinal instrumentation placed at the time of 28291 requiresimplant and code 28295 is
surgery. performed proximally; therefore, neither of these
a. 22551, 22585-51 codes is appropriate.
b. 22551-RT, 22585-51-RT
c. 22845
d. 22845, 22585-RT, 22551-51-RT - - Cast/Splint Application
22845, 22585-RT, 22551-51-RT Coding Breakdown: - -Musculoskeletal
system
Two levels of arthrodesis were performed, Applications of casts and strapping Cast/splints
requiring two procedure codes for this portion of Upper/lower body
the procedure, 22551 and 22585. Spinal
instrumentation is separately reportable with
arthrodesis; therefore, also assign 22845. Assign Cast/Splint Application
the most significant procedure first (22845), Coding Concepts: - -The initial cast is
followd by additional procedures with modifiers included in the global allowance for a definitive
51/RT. Code 22585 does not require modifier 51 surgical procedure, and therefore is not
because add-on (+) procedures should not have separately reportable when billing the initial
modifier 51 appended. surgery.
Cast application is reportable when performed as
the definitive procedure, such as immobilization
Bunions of sprain, or when fracture is to be repaired at a
Coding Breakdown: - -Musculoskeletal later date by another provider/surgeon. Cast
system application is reportable with reapplication during
Foot and toes the global period (with modifier 58) or after the
Repair/revision/reconstruction postoperative period when medically necessary
(not for patient comfort). Most codes require
laterality RT/LT/50.
Bunions
Coding Concepts: - -Capsulotomy,
arthrotomy, neuroplasty, tenotomy, tenolysis, Patient presents to the physician's office a week
excision of bunion, and associated osteophytes following repair of a tibial/fibular fracture. The
at the first MTP joint are integral to the bunion original surgical cast has cracked, and a
