AAPC - American Academy of Professional Coders Musculoskeletal System Coding Questions and Answers — Questions and Answers
Question 1: A patient presents to the emergency department (ED) with a displaced fracture of the distal radius. The ED physician performs a closed treatment with manipulation and applies a short arm cast. The patient is instructed to follow up with an orthopedist for continued care. Which CPT® code and modifier combination should the ED physician report?
- 25600 and an E/M code
- 25605-54 (Correct answer)
- 29075 and an E/M code
- 25505-54
Correct answer: 25605-54
CPT® code 25605 correctly identifies the closed treatment of a distal radial fracture with manipulation. Since the ED physician is providing only the initial 'surgical' portion of the fracture care and not the subsequent follow-up care (which is part of the global package), modifier -54 (Surgical Care Only) is required to be appended. Code 25600 is for a similar fracture without manipulation. Code 29075 is for the cast application, which is bundled into the fracture care code when it's the initial treatment. Code 25505 is for a radial shaft fracture, not a distal radius fracture.
Question 2: According to CPT® guidelines, when a surgical arthroscopy is performed, which of the following procedures is typically considered an integral part of the service and is NOT reported separately for the same joint?
- A partial meniscectomy in a different compartment
- A major synovectomy
- Diagnostic arthroscopy (Correct answer)
- Abrasion arthroplasty
Correct answer: Diagnostic arthroscopy
CPT® guidelines explicitly state that a diagnostic arthroscopy (e.g., 29870 for the knee) is always included in a surgical arthroscopy when performed on the same joint during the same session. If a diagnostic scope leads to a surgical scope, only the surgical scope is reported. The other answer choices are therapeutic surgical procedures that are typically reported separately, although specific bundling rules may apply depending on the primary procedure performed.
Question 3: A surgeon performs a posterolateral arthrodesis at a single level, L4-L5. An autograft is harvested from the iliac crest through a separate skin incision. Which CPT® codes correctly report the arthrodesis and the bone graft?
- 22612, 20937 (Correct answer)
- 22612 only
- 22614, 20936
- 22558, 20937
Correct answer: 22612, 20937
CPT® code 22612 represents posterolateral arthrodesis, single level, in the lumbar spine. CPT® code 20937 is the correct add-on code for an autograft harvested from the iliac crest through a separate skin incision for use in a spinal surgery. Code 22614 is an add-on code for each additional vertebral segment, not the primary procedure. Code 20936 is for a local autograft obtained from the same incision. Code 22558 is for an anterior approach, not posterior.
Question 4: A patient undergoes an open repair of a rotator cuff tear on the right shoulder and a diagnostic arthroscopy on the left knee during the same surgical session. Which modifier combination is most appropriate for the diagnostic knee arthroscopy?
- -50
- -51
- -59, -LT (Correct answer)
- -RT
Correct answer: -59, -LT
Modifier -59 is used to indicate that a procedure is distinct or independent from other non-E/M services performed on the same day. In this scenario, the knee arthroscopy is performed on a different anatomical site (left knee) than the primary procedure (right shoulder), making it a distinct service. Modifier -LT is necessary to specify that the procedure was performed on the left side of the body. While modifier -51 indicates multiple procedures, modifier -59 provides greater specificity that the procedures are separate and not bundled. Modifier -50 is for bilateral procedures, and -RT is for the right side.
Question 5: A patient undergoes a Keller-type bunionectomy on the right foot. During the same operative session, the surgeon also performs a correction of a hammertoe on the second digit of the same foot. Which CPT® codes and modifiers should be reported?
- 28296-RT, 28285-51-T6
- 28299-RT
- 28292-RT only
- 28292-RT, 28285-T6 (Correct answer)
Correct answer: 28292-RT, 28285-T6
CPT® code 28292 describes a Keller, McBride, or Mayo type bunionectomy. CPT® code 28285 describes the correction of a hammertoe. Since these are distinct procedures performed on the same foot, both are reportable. The anatomical modifiers provide the necessary specificity: -RT for the right foot (on the bunionectomy code) and -T6 for the second digit of the right foot (on the hammertoe correction code). 28296 is a different type of bunionectomy, and 28299 is for more complex repairs such as a double osteotomy.
Question 6: Which of the following scenarios allows for the separate reporting of a cast application CPT® code (e.g., 29000-29799)?
- Application of the first cast at the time of a closed fracture reduction.
- Application of a splint for initial stabilization in the ED before definitive fracture care.
- Application of a replacement cast during the 90-day global period by the same physician who performed the initial surgery.
- Application of a short leg cast for a severe ankle sprain when it is the only procedure performed. (Correct answer)
Correct answer: Application of a short leg cast for a severe ankle sprain when it is the only procedure performed.
The application of the initial cast or splint is included in the global package for fracture care and is not separately reported. Similarly, replacement casts applied by the same physician during the global period are generally not separately billable. However, when cast application is the definitive treatment for a condition that does not have a separate surgical procedure code (such as a sprain or contusion), the cast application code itself is the reportable service.
AAPC - American Academy of Professional Coders Musculoskeletal System Coding Questions and Answers
A patient presents to the emergency department (ED) with a displaced fracture of the distal radius.
The ED physician performs a closed treatment with manipulation and applies a short arm cast.
The patient is instructed to follow up with an orthopedist for continued care.
Which CPT® code and modifier combination should the ED physician report?