By: Jennifer Deddens

CPT Codes for Orthopedic Surgery Made Simple: Common Procedures and Their Rules

, RCM Manager, Professional Services

Orthopedic professionals often face a complex world of coding. If surgery wasn’t enough, trying to navigate the very specific codes for the procedures performed takes time. A small misunderstanding can lead to costly outcomes, including denied and delayed payments. Having a good grasp on CPT codes for orthopedic surgery can alleviate some of those frustrations.

 

What Are Orthopedic Surgery CPT Codes?

CPT codes are numerical sequences used to represent specific procedures provided by orthopedic surgeons for patients. From arthroscopies to full joint replacement, these codes inform insurance companies of the types of services provided, ensuring proper billing methods and, ultimately, payment.

Keep in mind that orthopedic surgery CPT codes are specific to surgical procedures for musculoskeletal conditions. Non-surgical treatment of musculoskeletal issues is coded separately and falls under orthopedic CPT codes without the ‘surgery’ designation. The codes discussed here are intended for use in orthopedic surgery, ensuring the proper communication of the care provided.

Codes developed by the American Medical Association describe the medical procedures provided and standardize reporting to payers. Consider these factors for accurately outlining the services provided in orthopedic surgery CPT codes:

  • All codes are five digits.
  • These codes are divided into three categories: I (Common codes), II (Supplemental and tracking codes), and III (Temporary codes).
  • Modifiers provide additional details about the procedure, such as the presence of multiple surgeons or bilateral procedures.
Orthopedic surgery coding involves a wide range of procedures, complex rules, and ever-changing guidelines, making it easy to miss details or risk claim denials.
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Common CPT Codes for Orthopedic Surgery

Numerous CPT codes exist for orthopedic surgery, but the following are among the most common.

Evaluation and management codes

Codes ranging from 99201 to 99499 typically fall under the Evaluation and Management (E/M) category. These cover a surgeon’s evaluation of the patient and management of services, factoring in complexity and time. E/M codes include evaluation, diagnosis, and treatment plan development.

  • 99203: New patient office visit, moderate complexity
  • 99213: Established patient office visit, low complexity
  • 99499: Unlisted E/M service
Anesthesia codes

Codes ranging from 00100 to 01999, as well as 99100 to 99140, relate to anesthesia services, including pre-operative evaluations, administration, and monitoring during surgery.

  • 00100: Anesthesia for procedures on salivary glands, including biopsy
  • 00400: Anesthesia for procedures on shoulder and axilla
  • 99140: Anesthesia for patients of extreme age or health complexity
Surgical procedures

Codes range from 10021 to 69990 and include most orthopedic surgeries. Examples include:

  • 20610: Arthrocentesis or injection of major joint/bursa without ultrasound guidance *(Most commonly performed orthopedic procedure, accounting for 21.8% of all orthopedic surgeries according to Definitive Healthcare)
  • 25215: Hand surgery, corpectomy, all bones of the proximal row
  • 64721: Neuroplasty or transposition of the median nerve at carpal tunnel
  • 23000-23929: Shoulder surgery, including arthroscopy and joint replacement
  • 22010-22899: Spinal surgery, including decompression, fusion, and disc replacement
  • 29500-29599: Open reduction and internal fixation (ORIF)
  • 27130: Total hip replacement
  • 27447: Total knee replacement *(Third most commonly performed orthopedic procedure, accounting for 4.9% of all orthopedic surgeries according to Definitive Healthcare)
  • 26055: Tendon sheath incision for trigger finger
  • 36415: Routine venipuncture *(Not an orthopedic surgery in itself, but frequently performed alongside major orthopedic procedures for lab testing and patient monitoring. Second most commonly reported orthopedic procedure, accounting for 5.5% of all orthopedic surgeries according to Definitive Healthcare)
Radiology codes

Codes from 70100 to 79999 cover imaging used for orthopedic diagnosis and monitoring.

  • 72010: Spine X-ray, two views
  • 73030: Shoulder X-ray, complete series
  • 73721: MRI, lower extremity, without contrast
Medication codes

Codes ranging from 90281 to 99299, and 80047 to 89398, cover medications used in surgical care, including wound care and injections.

  • 96372: Therapeutic, prophylactic, or diagnostic injection
  • 96365: Intravenous infusion, first hour
  • 96375: Each additional sequential intravenous push
Lab and pathology services codes

Codes ranging from 80047 to 89398 cover lab and pathology testing related to orthopedic care.

  • 80053: Comprehensive metabolic panel
  • 88305: Surgical pathology, tissue examination
  • 85025: Complete blood count (CBC)

Orthopedic Surgery CPT Rules and Guidelines to Note

Bundling

Bundled payments occur when multiple services are typically provided together as part of a main procedure. Instead of billing each service separately, they are included in the payment for the primary code. This applies to services that are expected and necessary for the procedure.

 

Global periods

Most major surgeries, such as total joint replacements, have a 90-day global period that includes the day of the procedure, preoperative visits, and routine postoperative care during those 90 days. Minor procedures typically have 0- or 10-day global periods, depending on the CPT code.

 

Modifiers

Another important component of CPT codes for orthopedic surgery (and orthopedic care in general) is the use of modifiers. This is a two-character code that will alter the definition of the CPT codes, often adding more information critical to the cost determination.

For example, the use of:

  • RT/LT: Side of the body (right or left) for procedures on paired structures
  • -50: Bilateral procedure
  • -59: Distinct procedural service
  • -74: Discontinued outpatient procedure after anesthesia
  • -77: Repeat procedure by another physician or qualified provider
  • -78: Return to the operating room for a related procedure during the postoperative period

Additional modifiers and CPT codes exist to enable the communication of the specific service provided. The CPT codes for orthopedic surgery should be accurate to provide clear information.

CPT codes for orthopedic surgery must be correct, but with so many unique codes and circumstances, it is very common for mistakes and omissions to occur. However, new technology is changing that, and the direct result is an improvement in cash flow for orthopedic surgeons and their practices.

*Disclaimer: This content is intended for informational purposes only and is not a substitute for professional coding advice.

Benchmark Solutions Enhances Efficiencies in Orthopedic Surgery Billing

To streamline efficiencies, improve effectiveness, and boost cash flow within your orthopedic surgical practice, consider utilizing Benchmark Solutions. We offer several tools and the experts you need to navigate the complexity of these costs.

 

Specialized RCM expertise

At its core, this is one of the most fundamentally beneficial services available. Our Benchmark RCM team understands orthopedic surgery coding, and that means we can provide comprehensive support to ensure accuracy, including helping to:

  • Prevent undercoding
  • Avoid unbundling errors
  • Reducing denials by ensuring claims are accurately coded and submitted

This includes applying global surgical packages to fracture care billing and more.

 

Comprehensive CPT code support

Beyond our outsourced services, our medical billing software ensures accurate code application supported by clinical documentation, with built-in automated coding recommendations that assist providers by suggesting the most appropriate CPT codes based on documented services.

 

Denial management and clean claims

You can also expect outstanding results from Benchmark RCM services and our medical billing software. We manage CPT code issues related to orthopedic surgery billing. This has resulted in a 98% clean claims rate across all specialties, ultimately leading to fewer delays, less rework, and faster payment.

Turn to Benchmark Solutions to find the best possible solution for mitigating risks of orthopedic surgical procedures. Set up a time to discuss your needs today!

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