Wiki Bone supplement HCPCS code needed

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martnel

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For the screws, for Cigna, we use C1713, and that got pd, but for the bone supplement and guidewires (see below), they denied - we did send in invoices/implant records/opreport, using L8699 for all these years, this is the first time this is denied:

~The ETX BSM/gamma calcium phosphate supplement was then prepared. Using approximately 4 cc of the 5 cc prepared, it was placed in the elevated portion of the lateral tibial plateau. After reaming over the guidewires, two 4.5 mm screws were then placed. ~

Does anybody have another code we can use? These Insurance companies keep on changing the rules on a daily basis, it's hard to keep up! LOL!
 
For in case anybody else needs this, here is the response from the Etex rep:


October 5, 2009
Coding is at the discretion of the provider. Coding information is provided here
solely as a reference.
A facility, whether inpatient/outpatient or hospital/surgery center, may choose to
code ETEX materials as the currently do for other bone graft materials.
There is not a specific CPT of HCPCS code for the implantation of ETEX
products, but each facility may have a pass through, revenue or carve out code depending on the insurance.
One code that may be relevant in an outpatient setting is a HCPCS Code, C1713. Anchor for opposing bone-to-bone or soft tissue-to-bone. This category now also applies to synthetic bone substitutes that may be used to fill bony voids or gaps (ie, bone substitute implanted into a bony defect created from trauma or surgery).
http://www.findacode.com/hcpcs/c1713-anchorscrew-opposing-bonetobone-softtissuetobone-
implantable-hcpcs-code.html
For the inpatient setting, one code that may be relevant is:
ICD-9 84.55, Insertion of bone void filler
Insertion of:
acrylic cement (PMMA)
bone void cement
calcium based bone void filler
polymethylmethacrylate (PMMA)
Excludes:
that with kyphoplasty (81.66)
that with vertebroplasty (81.65)
 
I have tried to open the link supplied above and cannot access it as I do not have a login for that site. Can you please provide what resource the link references as to what is included now in this code? I have looked at all of my resources and see nothing that includes bone substitutes, such as Etex.

Thanks for your help!
 
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