Orthopedic Coding Alert

Question: Your April 2007 article -Avoid These 5 Computer-Assisted Navigation Pitfalls- said to use 0054T-0056T to report computer-assisted navigation, but Medicare and Blue Cross/Blue Shield tell me to use an unlisted-procedure code for these services. I-ve always been taught not to unnecessarily use an unlisted-procedure code if a more specific one is available, even if it's a category III code. How should I report these procedures?

Maryland Subscriber

Answer: The CPT instructions at the beginning of the category III section state: -If a Category III code is available, this code must be reported instead of a Category I unlisted code ... The use of the codes in this section allows physicians and other qualified healthcare professionals, insurers, health services researchers, and health policy experts to identify emerging technology, services, and procedures for clinical efficacy, utilization and outcomes.-
 
Nonetheless, each payer may have its own rules for reporting these codes. In fact, Trailblazer Health Enterprises, the Medicare carrier for Maryland, indicates in a local coverage determination that all claims that include 0054T-0056T, among others, will be reviewed. Additionally, the LCD states that you must bill such claims using an unlisted-procedure code.
 
Consequently, you-ll have to use the unlisted-procedure code to report your orthopedist's computer-assisted navigation services to your Medicare carrier. But all payers don't follow the same rules. You should check with each to determine how they want these services reported. And get their directions in writing so you have documentation to back up your claims if payers ever call them into question.