CHAPTER 14 – Musculoskeletal Coding
Musculoskeletal System is formatted by anatomic site and then by procedure type,
condition, and description. – pg 424 in SBS TB, pgs 81-144 CPT Book
 Incision
 Excision
 Introduction or Removal
 Repair, Revision, and/or Reconstruction
 Arthrodesis – Surgical immobilization of a joint
 Amputation Coding Highlights
 Identify whether the procedure is being performed on soft tissue or bone
 Determine whether treatment is for a traumatic injury (acute) or a medical
condition (chronic)
 Identify the most specific anatomic site
 Determine whether the code description includes grafting or fixation
 Determine if the code describes a procedure on a single site or multiple sites
 Codes in the introduction or removal category are for unilateral services, so if a
procedure is bilateral, you would use RT/LT or 50. Please check carrier
guidelines.
Fractures and Dislocations
CPT Definition of a Fracture - pg 427 SBS TB, pg 86-87 CPT Book
 Open means the fracture has broken through the bone cortex or the bone has
been exposed to air
 Closed means the fracture does not penetrate bone cortex or the bone is not
exposed to air.
CPT Definition of Types ofTreatment - pg 425 – 427 SBS TB, pg 86-87 CPT Book
 Open Treatment – surgery is performed in which the fracture is exposed by an
incision made over the fracture and the fractured pone is visualized. In other
words, the patient is being cut open so the surgeon can view the bone.
 Closed Treatment – the physician repairs the bone without cutting the patient
open to view the fracture.
o Manipulation – reduction, doctor may bend, rotate, pull, or guide the bone
back into place
o Without manipulation – broken bone is immobilized with a splint, cast, or
other device
o With Manipulation – doctor puts the bone back in place , ex. Broken nose
o Open treatment – bone is outside the skin – doctor uses pins, screws, etc.
to fix
25500 – used when a patient has a broken but stable radial shaft that is not displaced
and the physician only applies a cast.
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CHAPTER 14 – Musculoskeletal Coding
Note:
 Initial casting or splinting services are included in the fracture care, but the
supplies are not.
 Initial splinting or casting of fractures performed by another physician as the only
service can be reported by that physician.
 If the cast needs to be removed and reapplied during the global period, the
surgeon that charged the global fee may report the cast/splint application with
29000 – 29799 and append modifier -58 (staged or related procedure/service).
 Just can’t bill for the removal of the cast if the cast is not being replaced.
Traction – the application of pulling force to hold a bone in alignment – pg 427 SBS TB
o Skeletal traction – use internal devices such as pins, screws or wires that
are inserted through the bone and sticks out the other end.
o Skin traction – using strapping ,elastic wrap, or tape that is fastened to the
skin or wrapped around the limb
 Percutaneous – the fracture is not open or closed but pins are placed across the
fracture site, usually under x-ray imaging.
Definition of Dislocation / Treatment – pg 429 – 430 SBS TB
Dislocations – displacement of a bone from its normal location in a joint
Treatment – return the bone to its normal location
CPT Index: pg 81 - 85
Incisions – 20000.20005 – Incision of a soft tissue abscess that is superficial or deep
Note: Do not use the integumenary system for coding the above. Why? The absecess
is associated with the deep tissue and possibly even down to the bone that underlies
the area of abcess. The physician would make an incision into the abscess, explore,
and clean the abscess, and debride it if necessary.
Wound Exploration – 20100-20103 – pg 432 SBS TB
Wound exploration codes report traumatic wounds that result from a penetrating trauma
(ex. Gunshot, knife wound, etc.) The repair requires enlargement of the existing wound
for exploration, cleaning and repair.
Note: Cannot bill these items separately as the exploration, enlargement of the wound,
debridement, removal of any foreign body(ies), ligation of minor blood vessel(s), repair
of subcutaneous tissues, muscle fascia, and muscle are included in the procedure code.
Note: If the wound does not require enlargement, you would report a code from the
Integumentary system, Skin Repair codes.
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CHAPTER 14 – Musculoskeletal Coding
Excisions – 20150-20251 – pg 433 SBS TB
This category is used for the biopsies of muscle and bone.
Biopsy codes do not include the pathology workup that is performed on the sample.
General Introduction or Removal – pg 433 - 434SBS TB, pg 88 CPT Book
 Sinus: 20500 – 20501 - Cyst or abscess inside the body with a tract (known
as a fistula) connecting to another surface – internal (to the gut) and external
(to the skin)
 Removal – 20520 – 20525 – report removal of foreign bodies that are lodged
in the muscle.
 Injections are for those injections made into a tendon, ligament, or ganglion
cyst.
Read Coding Shots located throughout the chaper
Arthrocentesis – 20600-20610 – aspiration of a joint pg 434 SBS TB
Small joints – finger, toe
Intermediate – ankle, elbow
Major – shoulder, hip
Note: anesthesia is included in these procedures
Incision of Wires or Pins to repair the bone – 20650
Removal of the External Wires or Pins – 20670, 20680
Implant removal codes – 20670, 20680
External Fixation – 20690, 20692, pg435-436 SBS TB
The device is placed on the outside of the body and pins or wires are placed into
the bone from the outside.
Note: See coding shot on page 435 SBS TB
Grafts (or Implants)
Grafts (Implants) – 20900-20938, pg 437 SBS TB
 Fascia lata grafts – grafts taken from the lower thigh area because the fascia
is the thickest in this area.
 Tissue grafts – include obtaining of the fat, ermis, paratenon (fatty tissue from
the tendon compartment) and other tissue type.
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CHAPTER 14 – Musculoskeletal Coding
Other Procedures – 20950-20999, pg 438 SBS TB
Monitoring of interstitial fluid pressure a procedure where the physician inserts a
device into the muscle to measure the pressure within the muscle.– 20950
Bone grafts – 20955-20962
Free osteocutaneous flaps bone grafts that include the skin and tissue
that overlie the boan– 20969-20973
Electrical or ultrasound stimulation – low voltage electricity or ultrasound is
appled to the skin– 20974-20979
Computer-assisted surgical navigation – 20985
Spinal Instrumentation and Fixation – pg 437 SBS TB
20930 – 20938 – used for the reporting, obtaining, and shaping of the tissue, whether
from a patient (autograft) or from a donor (allograft)
Spine (Vertebral Column) – 22010-22899
C1-C7 – Cervical
L1-L5 – Lumbar
T1-T12 - Thoracic
Arthrodesis – Use modifier -51 when arthrodesis is performed with a more major
procedure
Read Coding Shot on pg 439 SBS TB
Spinal Instrumentation – pg 439 SBS TB
 Segmental Instrumentation – the attachment of a fixative device at each end
of the area being repaired and at least one other attachment in the spinal
area is being repaired.
 Non-segmental Instrumentation – application of a fixative device at each end
of the area being repaired.
Foot and Toe Repairs – 28290 – 28299, pg 440 SBS TB
Hallux – great toe (big toe)
Eponyms – many of the procedures are named after a person
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CHAPTER 14 – Musculoskeletal Coding
Application of Casts and Strapping – 29000-29799
 Strapping – taping of a body part for stability
 Splints – made of wood, cloth, metal, or plastic. Used to immobilize, support
a protect a body part
 Removal – of a cast, strapping, or splint. This is included in each of the
Application of Casts and Strapping Codes
 Fracture Repair – if any of the above are put on the patient, included in the
procedure. If done within the follow-up period for either the surgical
procedure or fracture repair – use modifier 58
Pg 442 SBS TB – Be sure to read and add to CPT Book if not already there
Endoscopy/Arthroscopy – pg 443 SBS TB
Arthroscopy – uses small incisions which reduces the risk of infection and speeds
recovery
Note: When arthroscopy is performed in conjunction with arthrotomy, add modifier -51.
pg 443 SBS TB, pg 141 CPT Book
Note: A diagnostic arthroscopy is always included in a surgical arthroscopy. – pg 444
SBS TB
Virtual Knee Surgery - participate
http://www.flash-game.net/game/1554/virtual-surgery.html
Virtual Hip Surgery - participate
http://www.edheads.org/activities/hip/swf/index.htm
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