Orthopedic Coding Alert

Simplify choosing comparison codes with these expert suggestions

You may only be able to report 29999 once per claim, but you could be shortchanging yourself if you submit only one comparison code every time.

Reality: Many orthopedic codes date back to before 1990, so your frequent need for pesky unlisted-procedure codes shouldn't come as any surprise. Arthroscopic labral repair of the hip is no exception, but you can boost your efficiency by knowing when to turn to 29999 (Unlisted procedure, arthroscopy) and how to convince payers what your surgeon's services are worth.

The procedures: When NSAIDs, physical therapy, corticosteroid injections and other conservative labral tear treatments fail, the surgeon may perform arthroscopic resection or repair.

Snag: The repair procedure doesn't have a dedicated CPT code.

What to do: Follow our experts- recommendations on reporting four common arthroscopic procedures, including how to make the most of your unlisted-procedure claims.

1. Look for Labrum Debridement Code

If the surgeon performs arthroscopic labrum debridement only, you-re in luck because CPT offers a specific code for this procedure.

You should report 29862 (Arthroscopy, hip, surgical; with debridement/shaving of articular cartilage [chondroplasty], abrasion arthroplasty, and/or resection of labrum), says Annette Grady, CPC-Ortho, CPC-H, CPC-I, CPC-P, CCS-P, PCS, FCS, senior orthopedic compliance auditor with The Coding Network, in her audioconference for The Coding Institute, "Hot Topics in Orthopedic Surgical Coding" (available at http://www.audioeducator.com/industry_conference.php?id=993).

2. Debridement + Osteoplasty = Extra Work

The surgeon may perform arthroscopic acetabular and femoral neck osteoplasty with arthroscopic labral debridement, Grady says.

In this situation, you should report 29862 for the debridement and add 29999 for the osteoplasty, Grady says.

Rationale: CPT doesn't offer a specific code for these osteoplasty procedures, so you must report an unlisted- procedure code. Remember: CPT guidelines instruct that you should not report a code that "merely approximates the service provided."

To earn appropriate unlisted-procedure payment, you need to do some groundwork. Insurers often pay for an unlisted-procedure claim by reading your procedure description and comparing it to a similar, listed procedure with an established reimbursement value.

Try this: Do the payers- work for them and reference the nearest equivalent listed procedure in your explanatory note. The comparison code should require a similar skill-set and complexity factor, Grady says. Benefit: Offering a comparison helps prevent fights with the payer over reimbursement.

You may compare the arthroscopic acetabular and femoral neck osteoplasty to 27070 (Partial excision [craterization, saucerization] [e.g., osteomyelitis or bone abscess]; superficial [e.g., wing of ilium, symphysis pubis or greater trochanter of femur]), Grady says. Note: Code 27070 has 21.78 transitioned facility total relative value units.

Important: You should always check your surgeon's recommendation for a comparable surgical procedure, Grady says. As the one who performed the procedure, he should have the final say on the comparison code.

For example, your surgeon may decide that 27071 (- deep [subfascial or intramuscular]) or 27161 (Osteotomy, femoral neck [separate procedure]) better matches the procedure he performed than 27070.

3. Compare Labral Repair to Capsulorrhaphy

When the surgeon performs an arthroscopic labral repair alone, you must return to unlisted-procedure code option 29999.

You want to be sure you put your best foot forward for labral repair payment because the procedure is difficult and requires advanced training.

Grady advises comparing the procedure to 29806 (Arthroscopy, shoulder, surgical; capsulorrhaphy). This code has 27.71 transitioned facility total RVUs.

4. Chondroplasty, Too? Add New Comparison Code

Surgeons may provide acetabular and femoral neck osteoplasty and chondroplasty with labral repair.

Because you should report 29999 only once on your claim, proper comparison codes are crucial to proper reimbursement.

In this case, send both 29806 and 27070 as your comparison codes, Grady says. You should send both codes to reflect the procedure's increased complexity, she says.

Bonus: Make the Most of Unlisted Claims

Each time you file a claim using an unlisted-procedure code, you should submit a cover letter and the full documentation of services.

Here's how it helps: Insurers consider claims for unlisted-procedure codes on a case-by-case basis. As the go-between for the physician and the claims reviewer, you can provide a description of the procedure in layman's terms to boost your chance of fair reimbursement. If the person making the payment decision can't understand what the surgeon did, payment likely won't reflect the actual work.

Tip: You can even include diagrams or photographs to help the insurer better understand the procedure. "We highlight or make notes on the actual op report indicating where in the body of the op report the unlisted procedure is being described," says Melanie Uitto, CPC, CMC, coder at the CORE Institute in Sun City West, Ariz.

Provide specific details: You should also note how the unlisted procedure differs from the next-closest listed procedure, comparing the following, as appropriate:

- difficulty

- specific times

- complication risks

- recovery time

- postoperative requirements

- training, skills and equipment.

Don't miss: Some payers don't assign a global period to an unlisted-procedure code, so check with your major payers. You may be able to bill for E/M services postoperatively.