COSC flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Valgus deformity

A malalignment in which the distal segment of a bone or joint deviates away from the midline, producing an outward angulation; colloquially knee valgus is knock-kneed.

Operative report elements

A complete operative report documents preoperative and postoperative diagnoses, procedure performed, surgeon, assistants, anesthesia, indication, findings, technique, implants, estimated blood loss, specimens, and complications.

Open reduction

Surgical exposure of a fracture through an incision to directly visualize and align the fracture fragments; open refers to the soft-tissue approach, not whether the fracture broke the skin.

Sagittal plane

An anatomic plane that divides the body into left and right portions; a midsagittal plane passes through the midline, while parasagittal planes are parallel to it.

Laterality documentation

Identification of right versus left for paired organs, joints, and limbs; required for accurate CPT and ICD-10-CM coding and to prevent wrong-site surgery.

Closed fracture care global

CPT fracture-care codes for closed treatment include the initial reduction and application of cast or splint when performed by the same physician, plus routine follow-up care during the global period.

Percutaneous fixation

Stabilization of a fracture using pins, screws, or wires inserted through small skin incisions without direct fracture visualization; coding depends on the documented approach and implant.

External fixation coding

CPT 20690 describes application of a uniplane external fixation system; 20692 describes a multiplane system. Removal under anesthesia may be separately reported with 20694.

Open fracture treatment

Surgical treatment of a fracture through an incision with direct visualization and reduction; the CPT code includes the approach, reduction, and internal fixation when performed.

Dislocation reduction coding

Closed reduction of a dislocation is reported with a site-specific CPT code; open reduction requires a different code and is selected when surgical exposure is documented.

Diagnostic arthroscopy bundling

When a surgical arthroscopy is performed in the same joint during the same session, the diagnostic arthroscopy is not separately reported because it is integral to the surgical procedure.

Arthroscopic meniscectomy

CPT 29880 reports medial and lateral meniscectomy, while 29881 reports a single compartment; documentation must identify the compartment and whether debridement or repair was performed.

ACL reconstruction includes

Arthroscopic ACL reconstruction, 29888, includes graft harvest when performed, notchplasty, and fixation; a concomitant meniscectomy may be separately coded when distinct.

Arthroscopy documentation

The operative note should list portals, compartments examined, arthroscopic findings, procedures performed, implants, tourniquet time, and any conversion to open surgery.

Total knee arthroplasty

CPT 27447 reports total knee arthroplasty and includes the arthrotomy, capsulectomy, osteophytes, and implant insertion; it does not separately report routine synovectomy or capsulotomy.

Revision arthroplasty

A revision joint replacement code generally includes removal of the existing prosthesis and insertion of the new components; removal is not separately coded unless a distinct procedure is documented.

Spinal fusion level

A spinal fusion level is a motion segment between two adjacent vertebrae; coding counts each interspace fused, and instrumentation add-on codes are reported per additional segment.

Autograft harvest coding

Harvest of autogenous bone graft for spinal fusion is reported with 20936 for local or 20937 for tricortical iliac crest; allograft use is reported with 20930 or 20931 when documented.

Unicompartmental knee

CPT 27446 reports unicompartmental knee arthroplasty for a single compartment; it is distinct from total knee arthroplasty and requires documentation of limited disease.

Seventh character A

In ICD-10-CM injury codes, the seventh character A denotes the initial encounter for active treatment of the injury, not necessarily the first visit.

Seventh character D

In ICD-10-CM injury codes, seventh character D denotes a subsequent encounter for routine healing or recovery after the initial treatment of the injury.

Pathologic fracture

A fracture through bone weakened by disease, such as tumor or osteoporosis; coding requires the underlying condition and the fracture site, with specific ICD-10-CM categories.

Periprosthetic fracture

A fracture occurring around an orthopaedic implant, coded with M97.- by site; documentation should identify the joint, implant, and whether the fracture is displaced.

External cause code

An ICD-10-CM code from Chapter 20 describing how an injury occurred; it is reported as a secondary diagnosis and is never the principal diagnosis for an injury.

Modifier 25

Modifier 25 indicates a significant, separately identifiable evaluation and management service by the same physician on the same day as a procedure or other service.

Modifier 24

Modifier 24 reports an unrelated evaluation and management service during the postoperative global period of a procedure; documentation must show the service is unrelated to the original surgery.

Modifier 59

Modifier 59 identifies a distinct procedural service that is not ordinarily bundled; payers prefer the more specific X{E,S,P,U} modifiers when documentation supports them.

Global surgical package

The global package includes preoperative care, the procedure, and routine postoperative care for the global period; separately billable services must meet modifier and documentation rules.

NCCI PTP edit

A National Correct Coding Initiative procedure-to-procedure edit pairs codes that should not be billed together; the column one code is payable and the column two code is denied unless a valid modifier applies.

MUE

Medically Unlikely Edit sets a maximum number of units for a CPT or HCPCS code per patient per date of service; exceeding the limit requires exceptional documentation.

Medical necessity

The requirement that a service be reasonable and necessary for the diagnosis or treatment of an illness or injury, supported by documentation and payer coverage policies.

Incident-to billing

Incident-to billing allows a nonphysician practitioner's service to be billed under a supervising physician when the physician is present and the service is part of the physician's established plan of care.