Ch 15 Orthopedics

Orthopedic Services

Chapter 15

On your Own-
Review the brief CPT coding in Ch 16 Physical Therapy

Lets do a brief overview of the bones!

Quiz time!

Labelling

Label the bones

Drag labels to their correct position on the image

ulna

metatarsals

radius

tibia

sternum

humerus

patella

scapula

fibula

femur

Orthopedics

The Musculoskeletal System

Orthopedic doctors use codes from all through-out the CPT code book such as
E/M for office visits
Radiology for imaging
and especially the Musculoskeletal Subsection of the Surgery section
This is where you will find fracture repairs, joint replacements, bunion surgeries, casting, etc.

Get ready to test your abbreviation knowledge!

Match

Match the following

• TKA

• ORIF

• CRIF

• FX

• THR

a proc. where the knee joint is replaced

An open repair of a fracture

may be called pinning

fracture

an arthroplasty of complete hip joint

• a proc. where the knee joint is replaced

• An open repair of a fracture

• may be called pinning

• fracture

• an arthroplasty of complete hip joint

Format of the Musculoskeletal section of CPT Surgery

MUSC-ulo-SKELETAL
Includes muscles ligaments and tendons as well as bones
First organized by body area from head to toe
then divided based on the specific procedure

The EXCEPTIONS here are General, Casting/Strapping, and Arthroscopy

To get used to this section- try finding the code via table of contents first, then use the index for assistance

Med Term Refresher

-ectomy surgical removal
-desis surgical fixation/fusion
-tomy surgical incision
-plasty surgical repair
-centesis surgical puncture (often to remove fluid)
-scopy examination with a scope

​

Be careful with tumors

Watch the DEPTH

Tumor excision in this area (rather than skin) must be soft tissue such as sub Q, fascia, muscle, or bone.

Let's code!

Multiple Choice

Excision of 2cm benign subq tumor of right foot

• 28043

• 28045

• 28039

• 28041

Multiple Choice

Radical resection of SCC of mandible

• 21040

• 21025

• 21044

• 21045

Aspiration (and sometimes injection) of a joint
minimally invasive
done with a needle

often done on the bursae of a joint

Arthrocentesis

Surgical fixation or fusion of a joint, often times done on the spine, feet, and ankles, but any joint can be fused

Can be minimally invasive but is much more complex than a -centesis

Arthrodesis

Manipulation - forcing the bone back into place with manually

Not all fractures required manipulation
displaced vs. non-displaced

Traction- not the same as manipulation (uses straps and gravity instead of hands) sometimes pins and wires may be used.
skin vs. skeletal

Closed Treatment

The fracture site must be opened to set the fracture or insert fixation.

Internal fixation can be plates pins screws and wires.

Don't confuse this with PERCUTAENOUS SKELETAL FIXATION
Which is when the fixation goes through the skin and into the bone; may be called perc pinning

Open Treatment

​Fracture Repairs

The Fracture Repair Package

90 Day global period

Preop
The Procedure (open, closed, percutaneous)
We NEVER code 1st time casting/strapping/or splinting when a repair code has been used. The cast/strap/splint is included in the package
We can code replacement casts/straps/splints - application includes removal
99024 is for reporting a post op visit that is usually packaged

Fracture Coding 101

Was the repair:
-open or closed?
-with manipulation or without?
-with traction?
- With internal fixation?
-With percutaneous fixation?

Hips and Knees

hip: bipolar, just the femoral stem

knee: the medial OR the lateral compartment

Hemiarthroplasty

acetabular and femoral component (for hip)

medial and lateral compartments (for knee)

Total ____ Arthroplasty

OA
DJD
FX

Spinal Arthrodesis

Vertebral Segments/Interspaces

​Dont forget
Breakfast is at 7
Lunch is at 12
Dinner is at 5

If there is time....lets do some practice!