Once the recording is available, you'll be notified by email and it will be in the AOE Learning Center along with the presentation slides and some other materials. One more note here, we do want to encourage participation and collaboration and also maintain everyone's right to privacy. So with that in mind, we do not allow artificial intelligence software bots to attend our public or private events, including webinars. So if we see that there are any AI bots in the audience, we will be removing those from the meeting. So without further ado, we are going to get started with 2025 CPT changes decoded. What orthopedic practices need to know? Our speakers for today are Misty Smith, CPC, COSC, and Anne-Marie Webb, CPC, CPB, CPMA, both with Bluegrass Orthopedics. So I'll be turning it over now to Misty and Anne-Marie to get us started. Thank you for that. Let me get my screen sharing here. All right, good afternoon, everyone. Happy to see you here today. We will be presenting on the 2025 updates for orthopedics. We hope this webinar is educational for you and helps you just break down some of the new changes for 2025. Just a little up-to-date. As of January 1st, we did have some new ICD-10 changes and CPT changes that went into effect. We had some new codes, we had some revision codes, and we also had some codes deleted. Particularly in orthopedics, we have to stay up-to-date with those and decipher how to code those as professionals and, you know, practice management. So we hope that this webinar will help you understand how to apply those changes. We will be going over four objectives today. Looking at the changes for the CPT code sets for 2025, understanding how to apply the new and revised codes accurately, assessing the coding changes for reimbursement and compliance, and lastly, looking at strategies to educate practice staff on implementing updated CPT guidelines for improved accuracy, which is always hard. There's so many Post-it notes around my desk of all the new changes already. Just a little disclaimer. Misty and I have over 10 years of orthopedic experience, but every day is a new learning day. Every day is, you know, finding out changes between the insurance providers and carriers for the new year for how to bill correctly. With ICD-10, we had 250 additions, deletions, and revisions. We do have some several new codes for the disease of the musculoskeletal system and collective tissue, particularly under M51 for thoracic and lumbar disc disorder. There are some new characters. We also have some updates in regards to the M51 category, M65 category for the synovitis, including some special characters. So we're going to break down those for you today in this webinar. Starting off with the M51.36 and M51.37, this is a new expansion requiring a sixth character. You will see that there will be some new additions with that 0, 1, 2, or 9, so that breaks it down for if there is lower extremity pain, discogenic pain, and or no discogenic pain. You've got the, if the provider doesn't mention, if there's any low back pain or lower extremity pain, you will have that 9 character, so it just breaks it down for the specificity of what the patient is experiencing. This is an example of what that M51.36 category discusses with the other intervertebral disc degeneration lumbar region. You have your M51.360, which talks about that 0 being with discogenic back pain only, or you may have that sixth character being a 1 for the lumbar region with lower extremity pain only, or a 2, which is the lumbar region with discogenic pain and lower extremity pain, and then, or the 9, like I mentioned, if the provider does not have that mentioned in the office note, you would definitely put that 9 as that sixth character, which is without mention of lower lumbar back pain or lower extremity pain. For the M51.37, this is the other intervertebral disc degeneration for the lumbar sacral region. Again, this breaks down those sixth character for this particular category, the lumbar sacral region. You have your 0 for your with discogenic back pain only. You have your 1 for the lumbar sacral region with lower extremity pain only, your M51.362, which is your other intervertebral disc degeneration lumbar sacral region with discogenic back pain and lower extremity pain, or that 9 again, when there is no mention of lumbar back pain or lower extremity pain. So you definitely want to make sure your note reflects the proper sixth character in regards to these two categories. This is a new code for 2025, M62.85, dysfunction of the metaphysitis muscle lumbar region. This is a group of deep, long, narrow muscles in the back that help stabilize the spine and enable specific control of the vertebral located on either side of the spine. You've got extended the, extend the back, rotate the spine. So you have to think, you know, definitely help with maintaining an upright posture, which we all have, you know, me sitting at my desk a lot. Definitely do not have the best posture. This can also cause chronic low back pain. So we did add a picture here that just kind of shows, you know, this new code that is definitely for all the way up the back and down from your C1 down to your sacrum. So you can see that those muscles on either side of the vertebral column that are definitely needed to help patient may experience, you know, pain of these metaphysitis muscles that require some additional workup, you know, to help stabilize that muscle structure. So that just kind of gives you an idea of where they're looking at for treatment and recovery. The M65.9, the tendesynnesis is a new code with specificity and laterality. So we specifically are adding your location. You can have a shoulder, upper arm, forearm, hands, thigh, lower leg, or ankle. So this code set expanded this category for that specificity and laterality. So here we have requiring that six character. And as you can see, there is a theme running throughout the orthopedic ICD-10 codes for this year, having that six character to show laterality, specificity for the particular guidelines now. So for M65.9, you have your shoulders, you've got, again, your upper arm, forearm for that six character. It's going to be your left or right modifiers or unknown. So that's going to be your one, two, or nine again. An example we have is M65.942, which is unspecified tendosynovitis of the left hand. So you see there that we did the two for left, which would be your six character in regards to your laterality specificity with that. We have added a slide here in regards to what that particular joint space might look like. As you can see here, your synovesis is that inflammation. And it's very small. It's very tiny. So they were able to expand this particular code set to help with that specificity. As you can see in the picture here, we did a knee. So you have that little bit of inflammation on either side of that joint space, which as we all know, can cause quite a bit of disruption for patients. We do have a new code instructional note update for the ICD-10 guidelines on the muscular skeletal system and connective tissue. So you see here they have taken away the M92.8, that code definition there. They've also added some new exclusions in regards to your M54 category for your lumbar with your sciatica. You see there the M54.3. We do have some new exclusions to exclude that intervertebral disc degeneration, lumbar region, and lower extremity pain only. You see there that that had that one, which we talked about earlier, in our M51 category to make sure you have your 0, 1, 2s, or 9s. So you see there there are some R exclusions in regards to these code sets. So you definitely want to confer back with your physician to make sure you are correct coding those ICD-10s. As you can see there, that M54.4, you have the exclusions there for the discogenic back pain and lower extremity pain. So those are your two codes, that six character being the two. So you definitely want to look into those. And then just the general M54.5, the low back pain. There are two exclusions, which is that 0, which is that discogenic back pain only. So it's always good to highlight some of those new changes for 2025, just where they have added some additional wording and make sure that you are using the correct ones that go with the patient's care. And then Misty is going to discuss some of the new CPT changes here in regards to what we have for 2025. Thank you, Anne-Marie. We're going to start with the CPT updates in this portion. CPT has released the 2025 list of new revised and deleted codes. We're going to discuss some of the most notable code changes for orthopedics. You can find the exhaustive list of changes in the CPT manual under Appendix B. So let's dive into the key changes for 2025. So telehealth brings 17 new codes for 2025, and you can see the breakdown on the slide. There are four for new patient audio video, four for new audio only, four for established synchronous audio video, and then four for established audio only, with the addition of CPT 98016 for the brief virtual check-in. It's important to note that code selection will be based on either MDM or total time. You'll need to review and revise any existing telehealth templates to reflect these updates. First we'll cover the deleted telehealth codes, along with some of the new CMS billing guidance. We'll move on to the rules of reporting the new codes, and finally we'll highlight the implications of the update on your practice. Audio only CPT codes 99441 through 99443 and HCPCS G20112 have been deleted for 2025. For CMS and payers who follow CMS guidelines, telehealth services will revert to pre-pandemic geographic location and site of service restrictions, except for exempt services such as behavioral health and ESRD-related services. Telehealth services for other Medicare beneficiaries will bill for their services under the payment policy by CMS utilizing the outpatient office-based ENM CPT codes 99202 through 99215, with appropriate modifier in place of service. Modifier 95 is appended for real-time audio and video, while modifier 93 is used for audio only. Place of service 2 is used when the patient is not at home during the telehealth encounter, and place of service 10 is used when the patient is at home during the telehealth encounter. Research and update your templates to make sure you're meeting documentation requirements for your telehealth capabilities used during the encounter. You'll need to carefully discern telehealth code selection. This table in the CPT manual is a great tool for that. You'll see the categories, new or established patient, synchronous or not, level slash unit reported, service reported, example, per day or per seven days or 14 days or per calendar month, and other E&M notations as well. You'll want to pay close attention to the notations. In this example, code set 98000 through 98007 cannot be reported with same-day in-person E&M. 98016 cannot be reported if related to an E&M in the prior seven days or leading up to an E&M in the next 24 hours. Consider potential pitfalls, not checking payer policies to determine who is following CMS billing guidance, improper reporting of deleted codes, claim denials due to incorrect modifier or place of service, insufficient documentation in reporting the use of telehealth capabilities, and ultimately a delay in payment. Staying current on the ongoing telehealth coding updates will help your practice avoid reimbursement delays and noncompliance. You can expect updates to come in March and then revise your plan to make changes as needed again. 21630 has been revised and is no longer a parent code. We see the deletion of 21632 due to low utilization. Radical resection of the sternum is most often used to address the uncommon metastatic tumors of the sternum. They usually originate from breast cancer, malignant melanoma, colorectal, renal cell, and cervical cancer. Radial resection should be performed for curative intent by achieving a tumor-free margin for metastatic sternal tumors. Removal leaves a significant defect in the chest wall that needs to be reconstructed to protect the lungs. Separately reportable reconstruction is usually done immediately after the resection using materials such as celiac crest autograft mesh constructs or inner acellular dermal matrix with a titanium plate. For the CPT 2025 code set, code 25447 has been revised by transposing the term interposition after the semicolon and adding the parenthetical phrase tendon. CMC arthroplasty is a surgical procedure where the damaged joint at the base of the thumb is removed and replaced with an artificial implant. The most common indication is severe CMC arthritis. Parenthetical notes advise against reporting 25310 and 26480 with either 25447 or 25448. This is a change as previously it was appropriate to report 26480 in addition to 25447 to capture the tendon transfer. New code 25448 has been established to report suspension arthroplasty including the transfer or transplant of the tendon and the interposition of tendons when performed. As a result, interposition is not separately reported for this procedure when it is performed. New CPT 64466 thoracic fascial plane block unilateral by injection or injections including imaging guidance when performed. This regional anesthesia is used to manage thoracic pain in particular during thoracic and rib treatments. It includes the injection of local anesthetic into fascial planes in the chest area to block pain signals. These blocks can reduce the need for postoperative opioids and improve recovery by treating the patient's pain in a more targeted manner. Code selection is driven by unilateral or bilateral by injection or by continuous infusion and lower extremity by injection or by continuous infusion. For example, a patient may have received a blunt force trauma to the chest or trunk area and is having trouble breathing due to the pain. Chest x-rays are ordered during the treatment the surgeon performs a unilateral fascial plane block by the continuous infusion. You'll want to pay special attention to the exclusionary parenthetical notes restricting the reporting of certain radiology codes as the terminology including imaging guidance when performed is part of the code definition. Reimbursement and compliance. You can avoid potential revenue loss when preparing for the new year code changes. Be sure to update fee schedules, billing software and charge slips to reflect the new codes and their current RVU details. Track reimbursement trends by routinely running reports to capture that data. For example, underpayments and then comparing it to your fee schedule. Sidestepping compliance, compromising compliance. Orthopedic practices can remain compliant with coding guidelines by investing in ongoing education of revenue and pertinent clinical staff by updating templates to capture the current requirements that any coding changes can bring about. For example, identifying inaccurate documentation of time spent when reporting a time-based code. Attending this webinar is a good first step towards compliance. You'll need a personalized plan for your orthopedic practice. Doing so will help you avoid revenue loss and becoming non-compliant. You'll also want to consider consulting LCDs for your area for any new or revised codes. This will help you in updating any templates you have in place and accurately capture the current requirements for your LCD. Implementation strategies. You'll want to consider these questions. Who? Your revenue cycle, your coding and billing staff, clinical staff, physicians, clinical assistants, medical scribes. What resources will you consult? Current coding manuals, CMN, and other resources that you may need. Current coding manuals, CMS, webinars such as this, and in-house trainings. And also how, how are you going to accomplish this? Asking these questions are going to be key in the implementation of the change into your practice. Your team matters. Having a mix of revenue and clinical staff will help keep everyone up to date, making an easier transition for everyone. Investing in the current resources and keeping them in an easily accessible area. For example, maybe a shared drive. Identify the changes, discuss, and then put your plan into place. Once you have a plan that's tested and working well for your needs, you can update annually with the current coding updates. You'll want to note the above suggestion for guidance on which codes to focus on. This is key in protecting revenue. Focusing on higher RVU and higher volume codes for your practice should be your priority. Thank you so much for your time. Thank you, Anne-Marie, for co-presenting, and I think I will turn it back over to Jessica. All right, thank you so much for your information here. If anyone has questions, feel free to drop them in the chat and the Q&A, and we'll go over them. I have a couple of questions myself. I dropped this into the chat, so if others have any tips or tricks they want to share, feel free to drop it in there too. When it comes to training your team at Bluegrass on the new CPT codes, what methods have worked best for you all? Are you using online resources in person, something else, or a mix of several different things? I would say it's a mix of several things. I think time is key. We're all so busy with our daily coding responsibilities and billing, so if you choose maybe one person to attend different webinars, and especially when you get your new coding books for the year, you can go ahead and start to reference those, find the new codes, see what changes are in there, and how it's going to affect our practice, and then once you consult the resources, you would bring that person maybe to do an in-house training all at once so everyone's included. How are you all personally preparing for the coding changes every year? Is there anything that you find helpful as you're getting ready to see what's gonna be new, or like in the example of telehealth, trying to make sure that you're staying up to date with how often they're changing that, that you think would be beneficial for attendees today? I think definitely keeping up with the new coding books. We always make sure we get ours ordered, and a lot of our coworkers, they do the eBooks, so it's always nice we get them right then and there when the changes go into effect. October 1st is when ICD-10 always does their updates, so we always make sure that we're looking at CGS for any new updates that they have. They do their crosswalks that they send out, so we definitely send those out by email. We're always helping each other out with like, hey, this new article came out. We follow lots of different, like we do Codex, we do our AAPC, we get on there and look at different articles that they've submitted, so we do our monthly magazines. We definitely try to look at different facilities and articles and just make sure that we are getting everything we can, and then we all share it, like we do have a Google Drive that we share everything on together. Misty does updates and snapshots, and somebody might say, hey, I attended this webinar, I'm gonna put it in the slides, so we all try to help each other out, so we're working collectively as a team, and we do a really good job working together as a team. Yes, I would agree, and I think as far as telehealth, I think consulting the CMS websites is helpful, and like Amory said, as coders, we're always looking to get our CEUs, and so when these changes come out, there's always a good chance there's gonna be a lot of webinars to attend to get that education about the current changes, and again, platforms like AAPC or AHIMA, there's blogs and knowledge centers that produce a lot of resource that you can sort of track, and then again, it just falls to the responsibility as the coder and the billing staff to try to seek that information out, to stay abreast of it as, like we said, it's ever-changing and sort of a moving target at times. Great, I don't see any other questions that have come in, but if you have any follow-up questions, I'm gonna drop information here in the chat for Missy and Amory, and if anyone has follow-up questions for them, let us know or reach out to info at AOE.net, and we can always reach out to Missy and Amory for any kind of clarifying questions as well. This recording will be- Yeah, absolutely. Yeah, this recording will be available in the AOE Learning Center as well, along with the slides, and we'll have some other resources there for you as well, so once that's available, you'll receive the notification and you'll be able to disseminate the information with your team, and yeah, that's what we've got for you today. I wanna thank Amory and Misty for joining us and presenting on this topic. It's a lot to take in, and it's really important for everyone to stay up-to-date with what's different so that you can stay compliant. So thank you so much for presenting on this important topic and sharing this resource with our members. We're looking forward to seeing everyone on upcoming webinars. We have some things coming up next week, so don't forget to check out AOE.net special events so you can see what we have coming up, and we'll see you all next time. Thank you so much, and have a great afternoon. Thank you all so much for allowing us to come present. We love doing it, and again, she dropped our email addresses in there. Reach out to us. We're more than happy to help answer anything you guys may have. Great, thank you so much.

2025 CPT changes

orthopedic practices

ICD-10 updates

telehealth codes

billing systems

training resources

AOE Learning Center