Search results

  1. C

    Wiki Distal Femoral Fracture and Total Knee

    We were having the same issue with our MAC and the LCD guidelines governing total knee replacement. Our LCD covered both Total Hip and Total Knee arthroplasty. In reviewing the LCD, the DX codes supporting total hip replacement included 20 acute fracture codes but no acute fracture codes for...
  2. C

    Wiki Help!!!-POSTOPERATIVE DIAGNOSIS

    You may be looking at an unlisted code for the exicsion of the polypoid lesion, 67599 Unlisted procedure, orbit. On the other hand, is the tarsorrhaphy being done to protect the eye after excision of the lesion? In that case, the excision might be included in the tarsorrhaphy.
  3. C

    Wiki Foreign body earlobe

    There doesn't appear to be an x-ray code for just the earlobe, so this may fall under an unlisted code. Take a look at 76499 Unlisted diagnostic radiographic procedure as a possibility. You'll probably need to submit it with a comparable code if you use the unlisted code.
  4. C

    Wiki Arthrofibrosis

    In ICD-9 index, Arthrofibrosis, joint refers you to Ankylosis which are the 718.5x codes. Regarding status codes, take a look at V43.6x codes for status of a total knee. ICD-9 indicates that this V code is not acceptable as a first listed code.
  5. C

    Wiki ear tumor help

    The report states wide excision with flap closure. I'm wondering if this might not fall under 14060-61. You can't code 11646 with the 14xxx codes.
  6. C

    Wiki Help!!!-POSTOPERATIVE DIAGNOSIS

    Since your note states that the patient is unable to wear the prosthesis, I'm assuming the eye has been removed. Polypoid just means polyp like, I would concentrate on lesion and/or granulation tissue. If it's a lesion of the bony socket, ICD9 under Lesion directs you to 733.90 Disorder of...
  7. C

    Wiki Open rotator cuff recon vs repair

    Take a look at CPT Assistant February 2002 Coding Consultation: Questions and Answers. A definition of 23410/23412 versus 23420 is provided.
  8. C

    Wiki tibia operation, desperately need help

    It's hard to tell from the information provided, but this sounds more like a type of knee arthroplasty. You may want to take a look at the code range 27440 through 27446 and review them with the surgeon. Also, 27690 is for the ankle/foot area and I don't see the connection to the work the...
  9. C

    Wiki 29888,29881,29882

    Hate to add fuel to this discussion, but if you look at AAOS GSD for 29881 it indicates that 29882 is not included. If you look at AAOS GSD for 29882 it indicates 29881 is not included for other meniscus, other leg. I agree that all three can be coded if the meniscus repair and menisectomy are...
  10. C

    Wiki Closed treatment followed by planned ORIF of fracture

    This may fall under a modifier 58 situation. Take a look at Appendix A - Modifiers in the CPT manual and see if it applies to your situation.
  11. C

    Wiki What DX codes for pap exam with diagnosis charted by provider other than screening

    Take a look at V76 Speical screening for malignant neoplasms in ICD-9 in the tabular section. There is a coding tip under the code that states "Whenever a screening exam is performed, the screening code is the first-listed code regardless of the findings or any other procedure that is performed...
  12. C

    Wiki Ortho coders - would you recommend this book?

    It does have information on spinal procedures. You may also want to check out the North American Spine Society's Common Coding Scenarios for Comprehansive Spine Care.
  13. C

    Wiki CPT code 28086 with 28200

    If repair and synovectomy is being performed on the same tendon it will probably be the repair code. Run these codes through NCCI edits and review the AAOS GSD guidelines and I think you'll find the synovectomy bundles to the repair.
  14. C

    Wiki peroneal tendon debridement

    Since the pre and post op diagnosis is peroneal tendon tear and the surgeon is placing the tendons back into the groove after debridement and repairing the peroneal retinaculum which binds the tendons in place, it sounds like your first inclination of 28200 might apply.
  15. C

    Wiki peroneal tendon debridement

    Possibly 28220 which includes tenosynovectomy under AAOS GSD. Was the final DX tenosynovitis?
  16. C

    Wiki Patellar clunk syndrome after TKR

    Sounds like the surgeon is doing arthroscopic lysis of adhesions. Check w/the surgeon and see if 29884 is appropriate.
  17. C

    Wiki Graft Jackets

    Take a look at 1st Quarter 2006 AHA Coding Clinic titled Rotator Cuff Repair and Allograft Jacket. The graft appears to be inclusive of the repair code.
  18. C

    Wiki 29827 augmented with MaxForce graft jacket

    My understanding is that this code is to be used with the codes from the Integumentary section of the CPT manual. Also, the code descriptor was changed from (e.g., breast, trunk) to (i.e., breast, trunk) which seems to support the limitation to the Integumentary section. Also, take a look at a...
  19. C

    Wiki what dx code

    Take a look at 718.35
  20. C

    Wiki Symptomatic suture knots from prior Achilles tendon repair

    My opinion is that this diagnosis appears to fall under a complication of surgery and the description your doctor has provided is vague. You can ask the doctor to clarify what "symptomatic" means (pain, infection, etc?) or take a look at 996.7x codes as a possibility. It's generally best to...
  21. C

    Wiki Knee arthroscopy

    This is an addendum to my last post. It appears that AAOS has updated the wording in their current online GSD manual and based on those changes, placing modifier 59 on 29881 when coded with 29882 should allow both procedures to be paid without appeal.
  22. C

    Wiki Knee arthroscopy

    Example number 3 in the attached AAOS article supports coding both, but I've found that if you attach mod 59 to 29881 carriers will deny 29882 using the AAOS GSD Included guidelines for 29882. Even on appeal.
  23. C

    Wiki Medial Meniscectomy with Patellofemoral Debridement

    If synovium is being derided that would fall under 29875 and it appears that NCCI, CPT & AAOS all now agree that code 29875 can only be coded if it is the only procedure being performed since it has a Separate Procedure designation. If hard tissue is being derided it appears that it would fall...
  24. C

    Wiki Knee arthroscopy

    If the Not Included section of 29882 states Other Meniscus Other Leg it appears that the instruction is the other meniscus of the same knee OR one of the menisci of the other knee. If you have access to Margie Vaught at MedAssets you could pose the question to her or review her previous posts...
  25. C

    Wiki Knee arthroscopy

    In the AAOS GSD, under 29882 it states under Not Included Menisectomy both Other meniscus and Other leg. AAOS GSD for 29881 under Not Included states 29882 Repair of meniscus, other meniscus. It appears that you can do both a menisectomy and meniscus repair for the SAME knee as long as the...
  26. C

    Wiki 29822-59 separately??

    Take a look at 726.10 and see if it might apply for the tendinosis. A full thickness tear of supraspinatus would be 840.6 for traumatic and if chronic take a look at 727.61 as a possibility.
  27. C

    Wiki Is patella tendon repair included in hemipatellectomy?

    It bundles under NCCI edits and is included under AAOS guidelines, too.
  28. C

    Wiki Reverse total shoulder for 4 part fracture

    23410 and 23430 do bundle with 23472 under NCCI edits, so for Medicare and all carriers following NCCI you can't code those procedures. Check your American Academy of Orthopedic Surgeon GSD. I believe you can code under their guidelines if there is separate pathology for the rotator cuff &...
  29. C

    Wiki Synovectomy of IP joint??

    Sounds like he's in the IP joint, so possibly 26080 Arthrotomy with exploration, drainage or loose body removal. This code includes synovectomy under AAOS guidelines. If you think it's appropriate, you should review it with your doctor to see if he's in agreement.
  30. C

    Wiki TKA Coding Question

    You may want to consider 27447 rather than 27487. Per AAOS, 27487 would be incorrect for a reimplantation because revision surgery requires that an exchange of prosthesis be done at the same surgical session. You've indicated that your patient had already had the prosthesis removed. You'll...
  31. C

    Wiki Percutaneous fixation ankle Maisonneuve fracture

    It sounds like the surgeon is only addressing the ankle dislocation and not the fracture. Based on the information you've given, possibly 27842 Closed treatment of ankle dislocation requiring anesthesia, with or without percutaneous skeletal fixation. Did the doctor do a reduction of the fracture?
  32. C

    Wiki Proximal amputation of big toe

    How about 28150 Phalangectomy, toe, each toe as a possibility?
  33. C

    Wiki subacute fracture

    The definition in ICD-9 for 733.1x is a fracture due to bone structure weakening by pathological processes (eg, osteoporosis, neoplasms and osteomalacia). So if your chronic fracture is the result of a pathological process, I'd say that the 733.1x codes would apply. If the chronic fracture was...
  34. C

    Wiki Percutaneous fixation ankle Maisonneuve fracture

    Is the surgeon stating that the repair was done percutaneously?
  35. C

    Wiki Recomend a book on Spinal surgery Coding?

    You also may want to look at North American Spine Society Common Coding Scenarios for Comprehesive Spine Care. It's a manual produced by NASS.
  36. C

    Wiki Need help with Nonunion hip fracture repair

    Possibly 27470.
  37. C

    Wiki CPT Ankle Help!

    You might take a look at 27720-27725 repair of malunion/nonunion tibia.
  38. C

    Wiki Open Excision Cyst on Knee...

    Based on the information you've provided, in my opinion it sounds like the surgeon is removing the same ganglion using two different approaches. You can only code one and that would be the open procedure, 27347. If the ganglion had been removed exclusively by arthroscopy, you could consider...
  39. C

    Wiki Capsular plication shoulder-Hi fellow shoulde

    Is this for a Bankart repair or repair of the inferior labrum?
  40. C

    Wiki 29826 and Medicare

    Both AAOS and CPT have said that an unlisted code should not be used, that 29822 or 29823 are the appropriate codes depending on the extent of work done. Medicare, however, doesn't seem to have issued any clarifications on how to code arthroscopic SAD when it is the only procedure performed...
  41. C

    Wiki Medicare and 29826

    Anyone know if Medicare has put out an officicial policy on coding 29826 when it is the only procedure performed? Has CMS fallen in line with CPT & AAOS which tell you to use 29822 or 29823? Any help would be appreciated.
  42. C

    Wiki 29826 and Medicare

    Anyone know if Medicare has put out an officicial policy on coding 29826 when it is the only procedure performed? Has CMS fallen in line with CPT & AAOS which tell you to use 29822 or 29823? Any help would be appreciated.
  43. C

    Wiki 29826 and worker's compensation

    Hope I can get some help with this one. We're having trouble getting paid for 29826 with arthroscopic rotator cuff repair for Worker's Comp carriers that follow NCCI guidelines. 29827 is not on the OMFS schedule so we submit 29909 with a comparable code of 23410 or 23412 depending on whether...
  44. C

    Wiki Excision of osteophyte, talonavicular joint

    28104 might be a possibility.
  45. C

    Wiki CPT for PTT synovectomy

    Without posting the scrubbed report its hard to determine what code might apply, but for the open procedure 27626 Arthrotomy with synovectomy, ankle, including tenosynovectomy might be worth looking at. Read the lay description in Coder's Desk Reference and check it against your op report.
  46. C

    Wiki Right flank mass

    Take a look at 21930 thru 21936. They might be a possibility. You might look at the 11400 codes, too. You'll need dimensions of the mass documented in the operative report.
  47. C

    Wiki Help! Shoulder Surgery Mini Open twice?

    Take a look at what CPT Assistant 2008 for 29827 has to say regarding arthroscopic repair. Essentially, it says that for the arthroscopic procedure it doesn't matter if additional portals are used to repair different tendons. 29827 represents the repair of one, two or three tendons. I'm not...
  48. C

    Wiki excision of intraarticular scar tissue of knee

    Take a look at 29884 for lysis of adhesions and manipulation.
  49. C

    Wiki removal of calcific tendinitis with repair of RTC

    I don't think the resulting defect would be a complication of the surgery. Its the surgical approach to reach the calcific deposit and, like open surgery, whatever tissues the surgeon has to go through going in need to be repaired on the way out. I believe that is in NCCI guidelines as well...
  50. C

    Wiki Calcific tendinitis with rotator cuff repair

    For debridement, 29823.
Top