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)

Comments

  • edited May 2017
    Melanie,



    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
  • edited May 2017
    CPT Assistant May 2011 talks about not using 28120 for
    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
    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
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    (http://margievaught.com/)
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