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 [...]