Re: subchondroplasty for a trabecular fracture metatarsal head

CPT states in the CPT Assistant unlisted code

Margie Scalley Vaught, CPC, COC, CPC-I, CCS-P, MCS-P, ACS-EM, ACS-OR
Auditing, Coding, Documentation and Compliance Consulting
Healthcare Consultant_ scalley123@aol.com_ (mailto:scalley123@aol.com)
cell 360-880-8304
fax 413-674-7668_www.margievaught.com_ (http://www.margievaught.com/)
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In a message dated 11/15/2016 12:53:26 P.M. Pacific Standard Time,
nothling@ortholinc.com writes:


Margie~
Would you happen to know if there is any newer information regarding the
Subchondroplasty procedures. We are being told to use the ORIF codes, CPT
28485 for open fixation w/the cement of a metatarsal fracture. The only
information I can find is geared toward the Knees, anything about the
metatarsals?
Nikki


From: Scalley123@aol.com [mailto:Scalley123@aol.com]
Sent: Monday, February 08, 2016 5:53 PM
To: Multiple Recipients of Ortho-L
Subject: Re: [ortho-l] arthroscopic subchondroplasty for unicondylar
tibial fracture


CPT clearly states in the Jan 2014 Assistant:

Question: What Current Procedural Terminology (CPT) code should be
reported for a subchondroplasty procedure of the knee?
Answer: The subchondroplasty procedure is a minimally invasive repair
designed to treat subchondral bone defects associated with chronic bone marrow
lesions by filling them with a bone-substitute material. There is no
specific CPT code that accurately describes this service; therefore, unlisted
code 27599, Unlisted procedure, femur or knee, should be reported.
When reporting an unlisted code to describe a procedure or service, it is
necessary to submit supporting documentation (eg, procedure report) along
with the claim to provide an adequate description of the nature, extent, and
need for the procedure, and the time, effort, and equipment necessary to
provide the service."



Margie Scalley Vaught, CPC, COC, CPC-I, CCS-P, MCS-P, ACS-EM, ACS-OR
Auditing, Coding, Documentation and Compliance Consulting
Healthcare Consultant _scalley123@aol.com_ (mailto:scalley123@aol.com)
cell 360-880-8304
fax 413-674-7668_ www.margievaught.com_ (http://www.margievaught.com/)
facebook: margie s vaught
for workshops and audio_ http://www.margievaught.com/calendar/index.cfm_
(http://www.margievaught.com/calendar/index.cfm)
Want to receive a monthly newsletter - signup on _margievaught.com_
(http://margievaught.com/)
Check the calendar for audios/webinars and live presentations already
scheduled - 2016




In a message dated 2/8/2016 2:56:10 P.M. Pacific Standard Time,
_amcalevy@kearneyortho.com_ (mailto:amcalevy@kearneyortho.com) writes:

HELP!!! We have a physician who would like to perform a subchondroplasty
for a tibia fx utilizing the scope. This is a new procedure utilizing a
Calcium Phosphate mineral compound which is injected into the knee via the
scope. The rep is recommending we use CPT 29855/29856 and we think we should
be utilizing an unlisted scope code 29999 but we're not sure what HCPC
code to use for the bone substitute. Is anyone else performing this procedure
and what are you using as a CPT code and what code would you use for the
injectable. This is the 1st one we will have done, if we are able to get it
preauthorized for an ASC.

Thanks for any information you can pass along to us. 

Comments

  • One of my provider starting to perform this procedure.  Some times it is easy and in some cases it is complicated.  So if we are billing unspecified code then what code should we compare with specifically metatarsals and tarsals for both open and arthroscopy. 
  • Any update on this please?
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