This decision tree was created to assist coders in appropriate code selection for preprocedural services. Code selection includes the following sections from the Current Procedural Terminology code sets: Principal Care Management (PCM) Services (99424 to 99427), Prolonged Services (99358 to 99359), Prolonged Clinical Staff Services with Physician or Qualified Healthcare Professional (QHP) (99415 to 99416), and Prolonged Service with or without Direct Patient Contact on the Date of an Evaluation and Management (E/M) Service (99417 to 99418).
Published 7/30/2024
On April 9, the AAOS Coding, Coverage, & Reimbursement Committee hosted a webinar titled “Preprocedural Optimization Services.” The event was hosted by Stephen M. Engstrom, MD, FAAOS; John P. Heiner, MD, FAAOS; Frank R. Voss, MD, FAAOS; and P. Maxwell Courtney, MD. The panelists detailed for attendees the appropriate way to report preprocedural optimization services prior to total knee arthroplasty (TKA) and total hip arthroplasty (THA).
The comprehensive webinar explained the history of the issue when the 2021 Centers for Medicare & Medicaid Services (CMS) Medicare Physician Fee Schedule reduced the Relative Value Units for TKA and THA. The reduced reimbursement for the procedures did not account for the pre-service physician work involved.
AAOS and the American Association of Hip and Knee Surgeons were heavily engaged in this issue, participating in discussions with the American Medical Association and CMS, who both recognized that pre-service optimization work occurs with THA (code 27130) and TKA (code 27447). This webinar addressed the correct coding for work performed prior to surgery with principal care-management codes and highlighted a newly created decision tree to facilitate coding selection.
To listen to the recording of this important educational event, visit bit.ly/AAOSOptimization24. The recording will be available on the AAOS learning platform for 2 years.