Superior Capsular Reconstruction

Question:

What CPT codes do I use for comparison when the surgeon performs a superior capsular reconstruction? I know I have to use an unlisted code.

Answer:

Great job in knowing that this procedure is reported with an unlisted code. The AAOS recommends comparing this procedure to CPT codes 29827 and 29806.  Remember, the unlisted code is reported on the claim form; it is important to notate box 19 of the claim form the name of the procedure and the comparison codes for the unlisted code, 29999.

*This response is based on the best information available as of 07/11/19.

Subscapularis and Supraspinatus Repair

Question:

I perform an arthroscopic repair of the supraspinatus and subscapularis tendons through separate incisions/portals.   May I report CPT code 29827 twice?

Answer:

CPT code 29827, arthroscopic rotator cuff repair is reported one time regardless of whether one or all four tendons are repaired.  Consider adding modifier 22 for the additional complexity of the additional portals to accomplish the second repair.   Medical necessity for the additional portal must be supported.

*This response is based on the best information available as of 06/20/19.

Endoscopic Cubital Tunnel Release

Question:

If a cubital tunnel release is performed by endoscopy how should it be reported? We report 64718 when it’s performed as an open procedure. Just not sure how to report it when it is done by endoscope.

Answer:

Thanks for your submission.  There is currently no Category I CPT code for endoscopic cubital tunnel release.  The March 2009 edition ofCPT Assistantadvised that it would be correct to report the procedure using code 29999 (Unlisted procedure, arthroscopy).

You could use the open procedure code for comparison, 64718 (Neuroplasty and or/transposition; ulnar nerve at elbow), or the endoscopic carpal tunnel release code 29848 (Endoscopy, wrist, surgical, with release of transverse carpal ligament).

*This response is based on the best information available as of 5/23/19.

Laminoplasty

Question:

My surgeon did a C2-C7 laminoplasty and reconstructed with mini-plates. What code should I use?

Answer:

This procedure is reported using CPT 63051 (Laminoplasty, cervical, with decompression of the spinal cord, 2 or more vertebral segments; with reconstruction of the posterior bony elements (including the application of bridging bone graft and non-segmental fixation devices (e.g., wire, suture, mini-plates), when performed). CPT 63051 includes all levels of laminectomy required for the laminoplasty. It is not accurate to also bill a laminectomy code, such as 63001 or 63015, for procedures at the same level(s). CPT 63051 also includes placement of any instrumentation, such as the mini-plates, and fusion work performed at the same level, so do not also report an instrumentation code like 22842, or a fusion code such as 22600, 22614.

*This response is based on the best information available as of 4/25/19.

Call Coverage: Return to OR

Question:

I appreciate your patience in answering my Question:s.  I understand the E&M scenarios so let me throw in another type of call coverage relationship.  Recently, I returned a patient to the OR for the physician I was covering; the patient had dislocated their hip after a hip arthroplasty.  I reported CPT code 27266 without any modifiers; as I now understand the E&M rules I am wondering if I should have modified the code when I reported to the payor.

Answer:

Thanks for your comments and ensuring you are accurately reporting your call coverage scenarios.  CPT code 27266 is defined as “Closed treatment of post hip arthroplasty dislocation; requiring regional or general anesthesia “.   You are correct to present this scenario; the answer depends on whether or not the patient is in a global period.

If the patient is in the global period,you will append modifier 78, as the physician you are covering has to append this modifier.    Please note: if the patient had been in the global period and the hip dislocation was treated in the ER without anesthesia, the service would not be reportable according to Medicare rules.

If the patient is not in a global period, you may report CPT code 27266 without a global period modifier.

*This response is based on the best information available as of 4/11/19.

Bone Graft

Question:

My surgeon performed a repair of a nonunion with bone graft harvested via a separate incision.  The surgeon submitted CPT code 25431 alone.   I added CPT code 20902 after reviewing the operative note, because the surgeon obtained the bone graft from a distant site via a separate incision.   My surgeon disagrees with me and is firm that the harvest of the bone graft is not separately reportable.   Shouldn’t we be able to report the bone graft in addition to 25431 because of the separate incision?

Answer:

We appreciate your Question:! Although your physician did do the work of harvesting the bone graft from a separate incision, the rules associated with this code do not allow reporting 20902 (Bone graft, any donor area; major or large)

CPT code 25431 (Repair of nonunion of carpal bone (excluding carpal scaphoid (navicular)) (includes obtaining graft and necessary fixation), each bone) states in its definition the instructions “includes obtaining graft and necessary fixation).

You are correct that if a graft is obtained via a separate incision and is not inclusive to the code definition, or is not inclusive to a typical procedure, that the bone graft may be reportable in addition to the primary procedure.  For example, when a surgeon performs a subtalar arthrodesis defined by CPT code 28725 (Arthrodesis; subtalar) and harvests a bone graft from the proximal tibia, both 28725 and the bone graft (e.g.  20900 or 20902) may be reported.

*This response is based on the best information available as of 2/28/19.