Attachment A  - 2010 Payment Limits for Splints and Casts

X-RAY REPORTING

 AFTERCARE HEALING ICD-9 CODES

Here is some new updated from the guidelines updated Nov 2006:
"17. Chapter 17: Injury and Poisoning (800-999)
b.         Coding of Traumatic Fractures
The principles of multiple coding of injuries should be followed in coding fractures. Fractures of specified sites are coded individually by site in accordance with both the provisions within categories 800-829 and the level of detail furnished by medical record content. Combination categories for multiple fractures are provided for use when there is insufficient detail in the medical record (such as trauma cases transferred to another hospital), when the reporting form limits the number of codes that can be used in reporting pertinent clinical data, or when there is insufficient specificity at the fourth-digit or fifth-digit level. More specific guidelines are as follows:
1)        Acute Fractures vs. Aftercare
Traumatic fractures are coded using the acute fracture codes (800-829) while the patient is receiving active treatment for the fracture. Examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and treatment by a new physician.
Fractures are coded using the aftercare codes (subcategories V54.0, V54.1, V54.8, or V54.9) for encounters after the patient has completed active treatment of the fracture and is receiving routine care for the fracture during the healing or recovery phase. Examples of fracture aftercare are: cast change or removal, removal of external or internal fixation device, medication adjustment, and follow up visits following fracture treatment.
Care for complications of surgical treatment for fracture repairs during the healing or recovery phase should be coded with the appropriate complication codes.
Care of complications of fractures, such as malunion and nonunion, should be reported with the appropriate codes. Pathologic fractures are not coded in the 800-829 range, but instead are assigned to subcategory 733.1. See Section I.C.13.a for additional information.
1) Acute Fractures vs. Aftercare
Pathologic fractures are reported using subcategory 733.1, when the fracture is newly diagnosed. Subcategory 733.1 may be used while the patient is receiving active treatment for the fracture. Examples of active treatment are: surgical treatment, emergency department encounter, evaluation and treatment by a new physician.
Fractures are coded using the aftercare codes (subcategories V54.0, V54.2, V54.8 or V54.9) for encounters after the patient has completed active treatment of the fracture and is receiving routine care for the fracture during the healing or recovery phase. Examples of fracture aftercare are: cast change or removal, removal of external or internal fixation device, medication adjustment, and follow up visits following fracture treatment.
Care for complications of surgical treatment for fracture repairs during the healing or recovery phase should be coded with the appropriate complication codes.
Care of complications of fractures, such as malunion and nonunion, should be reported with the appropriate codes.
See Section I. C. 1 7.b for information on the coding of traumatic fractures.
ICD-9 Coding Clinic, Vol 23 No 4, 4th Qtr 2006"

ASSISTANT SURGEON:

The American College of Surgeons (ACS) has posted their updated 2007 Physicians as Assistants at Surgery Study on their website http://www.facs.org/ahp/pubs/2007physasstsurg.pdf

Over 20 organizations contributed for the Fifth Edition of this Study that was led by the College.  Each of the organizations were asked to review CPT procedures/codes and determine if a procedure would require the services of an assistant at surgery: 1) almost always 2) almost never or 3) some of the time.   Private payors have added this document to their repertoire of reference documents used in creating internal payor policies.

EXCISION LIPOMAS - MASSES

It is all going to depend on 'how low did you go'

In the CPT® Assistant, August 2006, Volume 16, Issue 8, it gives great information as to when to use the Integ System codes vs. Musculoskeletal codes.  It states "When a LIPOMA is present in a superficial location, it would be appropriate to use an excision code from the integumentary system (eg, 11400-11446, Excision, benign lesion). However, when the LIPOMA is in a deep subcutaneous, subfascial, or submuscular location, an appropriate code from the musculoskeletal system (eg, 21930, Excision, tumor, soft tissue of back or flank) would be reported to describe more closely the work entailed."

This is not a new policy as CPT Assistants before this 2006 one also referenced that the correct coding will be based on how deep the documentation states they went to excise.