Orthopedic Coding Alert
Acquire Preauthorization for 0012T
Question: I reported mosaicplasty with code 0012T (Arthroscopy, knee ...), but Cigna denied it because the service "has not been shown in the literature to have improved outcomes as compared to standard treatments." Because the surgery did not require preauthorization, I had no way of knowing it would be denied. Should I have reported an unlisted-procedure code instead? Answer: Unfortunately, not all insurers cover the Category III codes because this code set represents emerging technologies. This does not mean that you should report an unlisted-procedure code instead to avoid a claim denial. Code correctly, even if it means that you'll have to collect payment from the patient instead of the insurer. To avoid such denials in the future, you should always preauthorize any services to which CPT assigns a Category III code.
New Hampshire Subscriber
Some insurers publish policies outlining coverage criteria for these procedures on their Web sites, which can help you authorize the procedure quickly. Aetna, for instance, indicates in Coverage Policy Bulletin 364 that it covers mosaicplasty for nonrepairable stage-three or -four osteochondritis dissecans, as well as several other diagnoses.
Orthopedic Coding Alert
- Never Miscode Bankart Procedures Again - Thanks to CPT 2004
The new coding manual teaches coders how to boost reimbursement for this common arthroscopic procedure [...] - 2004 Fee Schedule Update:
Physicians Escape 4.5 Percent Cut for 2004
Medicare legislation raises conversion factor by 1.5 percent CMS offered orthopedists an early holiday gift [...] - Determine the Effect of the 2004 Fee Schedule on These Common Procedures
Visit the CMS Web site at http://cms.hhs.gov/physicians/ - CPT Clears Up Cloudy Starred Procedures
Don't let deleted 'stars' disrupt your private-payer claims The AMA has eliminated CPT's "starred procedure" [...] - Reader Question:
Use 'History of Cancer' After Removal
Question: We assisted an oncologist in treating a patient with secondary cancer of the femur [...] - You Be the Coder:
Will Medicare Pay for Post-Op Shoe?
Question: Our insurer suddenly stopped reimbursing us for the post-op shoe (L3260). Does this require [...] - Reader Question:
Choose 92950 for Resuscitation
Question: Our orthopedic surgeon was making rounds at the hospital today when he responded to [...] - Reader Question:
Modifier -58 Signals 2 Reductions
Question: I attempted to reduce a dislocated hip in the emergency department, but the procedure [...] - Reader Question:
Acquire Preauthorization for 0012T
Question: I reported mosaicplasty with code 0012T (Arthroscopy, knee ...), but Cigna denied it because [...] - Reader Question:
20605 Describes Wrist Aspiration
Question: I performed an orthopedic consultation at the hospital, where I also aspirated the patient's [...] - Reader Question:
Use Outpatient Codes for ED Consults
Question: Our orthopedist was recently on-call for the emergency department (ED). The ED physician asked [...]
