open allograft OCD lesion
Good morning,
I have a Dr who received a recommendation at the ACFAS conference last weekend to code for open allograft of talar OCD lesion using 28120 instead of using the unlisted. I said that CPT instructions state to use 28899
for this procedure, but he is insistent, so I just want other opinions. Would you code this as 28120 or 28899? Thank you!
Melanie Uitto, CPC, COSC
Coding Supervisor
The CORE Institute(r)
Center for Orthopedic Research and Education
F: 855.326.8110
www.thecoreinstitute.com
Keep Life in Motion!(r)
I have a Dr who received a recommendation at the ACFAS conference last weekend to code for open allograft of talar OCD lesion using 28120 instead of using the unlisted. I said that CPT instructions state to use 28899
for this procedure, but he is insistent, so I just want other opinions. Would you code this as 28120 or 28899? Thank you!
Melanie Uitto, CPC, COSC
Coding Supervisor
The CORE Institute(r)
Center for Orthopedic Research and Education
F: 855.326.8110
www.thecoreinstitute.com
Keep Life in Motion!(r)
Comments
It's my understanding that code 28120 should only be used if there's some
type of bone issue, such as osteomyelitis, necrosis, etc. This directive
came down from CPT within the last several years I believe. By using
28120, it would be misleading to the insurance companies because you would
not be correctly coding the procedure that was actually done and it could
be considered as a false claim. There are some insurance companies that
still consider autografting/allografting to the talus as experimental and
investigational. I would code the open allograft of the talar OCD lesion
with code 28899 as instructed by CPT. I do remember Margie Vaught
addressing the change in what to use code 28120 for. You may be able to
find something in the archives of this forum, or if you have her e-mail you
can send your question directly to her.
Sandi Hamrick, CPC
Toledo Orthpaedic Surgeons
exostosis/osteophytes but that it should be used for diseased bone.
I would also be careful using an existing CPT code as many payers have
policies of noncoverage and if you use an existing code they will pay thinking
that is what you did. If that claim is reviewed they will see that you
"knowingly misrepresented a service to circumvent a policy" which is a very
bad thing the Federal Register states.
You will also find a CPT Assistant regarding OCD of the talar dome stating
unlisted 28899 if there was an allograft code similar to 28446 then the
answer below would be the same for what the said for the knee as CPT feels
synthetic plugs and allograft would be the same:
Dec 2008 CPT Assistant:
"Question: Can any of the osteoarticular transfer system (OATS) procedure
codes (27415, 29867) be reported when the procedure is performed using
synthetic plugs only? Would the unlisted codes be more appropriate?
Answer: It would be appropriate to report code 29867, Arthroscopy, knee,
surgical; osteochondral allograft (eg, mosaicplasty), or code 27415,
Osteochondral allograft, knee, open, when synthetic osteochondral implants are
used instead of cadaveric bone and cartilage allograft.
In contrast for talar procedures using synthetic plugs, the unlisted
procedure code 28899, Unlisted procedure, foot or toes, should be reported. It
would not be appropriate to report either code 28446, Open osteochondral
autograft, talus (includes obtaining graft[s]), or code 29892,
Arthroscopically aided repair of large osteochondritis dissecans lesion, talar dome
fracture, or tibial plafond fracture, with or without internal fixation
(includes arthroscopy)."
Margie Scalley Vaught, CPC, COC, CPC-I, CCS-P, MCS-P, ACS-EM, ACS-OR
Auditing, Coding, Documentation and Compliance Consulting
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