These articles are part of our ongoing series dealing with the business of orthopedic billing.  New for 2017 for general orthopedic billing and coding is that there are two new codes for closed treatment of a posterior pelvic ring fracture/dislocation of the ilium, the sacral joint, and/or the sacrum.

 

New Orthopedic Codes:

CPT 27197 – Closed treatment of posterior pelvic ring fracture/dislocation of the ilium, the sacral joint, and/or sacrum. Unilateral or bilateral; without manipulation

2017 Medicare FS -$132.36

 

CPT 27197 is the procedure without manipulation.  This is one of those confusing codes that really is almost an evaluation and management service where you carry a 90-day global period and within that 90 days are managing the routine healing of that closed fracture even though it’s only been braced.

 

CPT 27198* – Closed treatment of posterior pelvic ring fracture/dislocation of the ilium, the sacral joint, and/or sacrum. Unilateral or bilateral; with manipulation

2017 Medicare FS -$329.76

*Code requires more than a local anesthesia, new moderate sedation codes may apply (coded separately).

 

CPT 99151 – Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring a trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status, initial 15 minutes, patient younger than 5 years of age

  • Medicare FS $90.14 in office setting

CPT 99152 initial 15 minutes, patient age 5 years and older

  • Medicare FS $60.61

CPT 99153 –each additional 15 minutes

  • Medicare FS $13.18

 

CPT 27198 is for the same treatment but this time including manipulation.  This code includes a requirement that there is moderate sedation or more than a local anesthetic.  There are some new codes that are related to these medical billing procedure codes.  CPT 99151 moderate sedation services has been recharacterized so that the moderate sedation is provided by the same surgeon who is providing the operative procedure.  The CCI edits permit separate additional reimbursement for these two codes when billed together.  In the past the moderate sedation was included in the reimbursement of the operative procedure.  Therefore, in order to get reimbursed, providers will need to document and report moderate sedation in addition to the operative procedure.

 

About Apache Health

Apache Health is a revenue cycle management (RCM) analytics, benchmarking, and auditing company. The founders of Apache formerly ran a large RCM company that was acquired by a private equity group in a rollup. Apache’s predictive analytics will benchmark billing performance and project exactly how much more revenue you should earn from your existing volume of patients.  Using many factors and a blend of artificial intelligence and specialty specific benchmarks, the model projects whether changing the billing process would improve collections for your particular mix of procedures and payers. Apache Health can help you evaluate whether to outsource the billing, determine which billing company to select to maximize performance, or track in-house billing performance improvement over time. For more information contact:

Sean McSweeney

Apache Health

www.apachehealth.com

888-422-5514