Orthopaedic Codes:

The Hip and Knee replacement procedures are also often miscoded.

The following codes are usually appropriate to charge in these specific procedures, but must be modified according to procedures actually performed by the anaesthesiologist and according to specific rules applicable.

Modifiers such as 0018 (BMI >35.0) and 0043 (Age > 70years) may apply and should be charged as appropriate.

Hip Replacement

Code	Description	Notes
0151	Pre-anaesthetic assessment: Pre-anaesthetic assessment of patient (all hours). Problem focused history and clinical examination and straightforward decision making for minor problem. Typically occupies the doctor face-to-face with the patient for between 10 and 20 minutes
0637	Hip: Total replacement
5445	Spine (except coccyx), pelvis, hip, neck of femur: Add five (5,00) anaesthetic units
0023	Anaesthetic time: The remuneration for anaesthetic time shall be per 15 minute period or part thereof, calculated from the commencement of the anaesthetic.
0039	Control of blood pressure: Deliberate control of the blood pressure: All cases up to one hour: Add 3,00 anaesthetic units, thereafter add 1,00 (one) additional anaesthetic unit per quarter hour or part thereof
2801	Procedures for pain relief: Epidural injection for pain (refer to modifier 0045 for post-operative pain relief) (refer to modifier 0021 for epidural anaesthetic)	If epidural block is performed for post-operative pain control
2804	Inserting an indwelling nerve catheter (includes removal of catheter) (not for bolus technique)	If epidural catheter is placed for post-op pain control
1221	Professional fee for managing a patient-controlled analgesic pump: First 24 hours (for subsequent days charged the appropriate hospital follow-up consultation/visit code)	If PCA/pump is placed for post-op pain control
0109	Hospital follow-up visit to patient in ward or nursing facility - Refer to general rule G(a) for post-operative care) (may only be charged once per day) (not to be used with items 0111, 0145, 0146, 0147 or ICU items 1204-1214)	Appropriate if patient is seen in hospital on subsequent day for monitoring of pain control

 

 Knee replacement

Code	Description	Notes
0151	Pre-anaesthetic assessment
0646	Knee: Total replacement
5442	Shoulder, scapula, clavicle, humerus, elbow joint, upper 1/3 tibia, knee joint, patella, mandible and tempero-mandibular joint: Add two (2,00) anaesthetic units
0023	Anaesthetic time: The remuneration for anaesthetic time shall be per 15 minute period or part thereof.
2802	Procedures for pain relief: Peripheral nerve block	If femoral block is done
2804	Inserting an indwelling nerve catheter (includes removal of catheter) (not for bolus technique)	If catheter is used with the femoral block
1221	Professional fee for managing a patient-controlled analgesic pump: First 24 hours (for subsequent days charged the appropriate hospital follow-up consultation/visit code)	If PCA is used with catheter in the femoral block, this code is appropriate.

 

Arthroscopy knee

Code	Description	Notes
0151	Pre-anaesthetic assessment
0614/0673	0614 Arthroplasty: Debridement large joints 0673 Meniscectomy or operation for other internal derangement of knee
5442	Shoulder, scapula, clavicle, humerus, elbow joint, upper 1/3 tibia, knee joint, patella, mandible and tempero-mandibular joint: Add two (2,00) anaesthetic units
0023	Anaesthetic time.

 

Claiming for a Labour Epidural

The "stand-alone" labour epidural as well as the epidural followed by a C-Section is  a frequent cause of issues around coding:

This is what Precision recommends to their clients and what has so far kept them out of trouble:

THE LABOUR EPIDURAL:
0151: Pre-anaesthetic consultation
2614: Global Obstetric Care
0023: Actual Time spent with patient - average 45-60 minutes in the "usual" patient
1221: If a PCA pump is set up and managed for infusion

Unless it is an elective induction of labour, the following can be added:
0146/0147 added to 0151
0011 for appropriate time

This far it is fairly straight forward:
Where many complaints come in is when the patient progresses to a C-Section

THE CAESAREAN SECTION:
What can/can't you claim now?
If the same anaesthetist inserted the epidural and charged the 0151, you cannot charge it again.
If a different anaesthetist manages the C-Section, it is appropriate to charge 0151 again.

You can charge the 0146/0147 again as appropriate.
Additional top-up times may be charged for time spent with the patient preparing the patient and epidural prior to admission to theatre.

In theatre:
2615: All inclusive fee for caesarean section
0023: Time spent with patient topping epidural and in theatre
0011: As appropriate

If you use a PCA afterwards a 1221 may be charged. Some confusion is created when hospitals forget to charge for the consumables, making it look as if the PCA was never used.

What is not usually paid for and causes complaints and investigations:
0039: Bloodpressure swings with spinals/epidurals/general anaesthetics happen, managing this is part of the anaesthetic. It is only appropriate to charge this code in obstetric care for the severe eclamptic patient or cardiac patient, and be prepared to motivate your charge.

2801: Insertion of epidural- as this is usually your main anaesthetic and therefore covered by 2614 or 2615, it is not appropriate to charge this as an additional code. This should only be charged if it was inserted for post-op pain control and a general anaesthetic was administered for the C-Section. The associated pain probably doesn't justify this as routine practice.

Coding Discussions

This blog will discuss coding issues, and will function in a question and answer format.
The intention is to ensure that Precision clients use all the appropriate codes for the various procedures in an ethical and acceptable manner. Any suggested codes for pain blocks, lines or bloodpressure control assumes that the procedure or line is actually performed or inserted.

An example of the type of procedure where codes are often missed is the shoulder acromioplasty where the following codes can potentially be used:
0151
0617
5442
0023
2800
0039
0034
0032

Welcome to the Precision Medical Solutions Blog

Watch this spot, we will be sharing regular Practice Management Suggestions