Wiki Codex software

[coder21]

Does anyone use Codex Software? My provider was telling me about it and he says that (the software states he can use codes together which are normally bundle?)

 

[klamond]

I have AAOS Code X for Orthopedics. They do provide a Global Service Data report (see example below) that you can use for appeals if a code was denied inclusive. However, they still follow NCCI edits and have the lists attached to the code when you look it up so there is easy access.



CPT Code: 29888
Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction

Services included in the global service package:
• local infiltration of medication(s), anesthetic, or contrast agent before, during, or at the conclusion of the operation
• suture or staple removal by operating surgeon or designee
• surgical approach, with necessary identification, isolation, and protection of anatomic structures, including hemostasis and minor skin scar revision
• obtaining wound specimen(s) for culture
• wound irrigation
• intraoperative photo(s) and/or video recording, excluding ionizing radiation
• intraoperative supervision and positioning of imaging and/or monitoring equipment by operating surgeon or assistant(s)
• insertion, placement, and removal of surgical drain(s), re-infusion device(s), irrigation tube(s), or catheter(s)
• closure of wound and repair of tissues divided for initial surgical exposure, partial or complete
• application of initial dressing, orthosis, continuous passive motion, splint, or cast, including traction, except where specifically excluded from global package
• preparation and insertion of synthetic bone substitutes, osteoconductive and osteoinductive agents (eg, hydroxyapatite, calcium phosphates, coral, methylmethacrylate, demineralized bone matrix, bone morphogenetic proteins), except where specifically excluded
• synovial resection for visualization
• diagnostic arthroscopy of knee (eg, 29870)
• manipulation under anesthesia (eg, 27570)
• harvest of graft from ipsilateral limb

Services not included in the global service package:
• conscious sedation, regional block(s), Bier block(s)
• supplies and medication (eg, code 99070, HCPCS Level II codes)
• insertion, removal, or exchange of nonbiodegradable drug delivery implants (eg, 11981-11983)
• arthroscopic meniscectomy or repair of meniscus (eg, 29880-29883)
• extra-articular augmentation (eg, 27427)
• arthroscopic chondroplasty, abrasion, multiple drilling or microfracture, separate compartment (eg, 29877, 29879)
• arthroscopic removal of loose or foreign bodies greater than 5 mm or through a separate incision (eg, 29874)
• arthroscopic drilling of osteochondritis dissecans (eg, 29886)
• arthroscopic transplant of meniscus (eg, 29868)
• arthroscopic repair/augmentation of posterior cruciate ligament (eg, 29889)
• abrasian arthroplasty or multiple drilling or microfracture (including chondroplasty where necessary) (eg, 29879)
• primary repair of torn ligament and/or capsule (eg, 27405)

Medicare global fee period: 90 days

 

[coder21]

Thank you! So if they follow the NCCI edits if the codes are truly not meant to be billed together than there is no way around it correct? My provider is trying to tell me that we need the software and that I can bill even though there is a NCCI edit.

 

[Orthocoderpgu]

You have to know if your insurance follows CMS NCCI or not

Your surgeon, like all other physicians, take a "cookie cutter" approach to coding surgeries. They think that every insurance can be billed the same, which is just not true.

Most insurance companies follow CMS NCCI edits. Many don't. So before you can code surgeries, you need to understand your payer which will drive your surgeon's crazy.

The Code-X global service data is very good for appeals, but most insurance do not follow AAOS.

On page 51 of the CPMA study guide it states: "To avoid unbundling, adhere to CPT coding guidelines and parenthetical instructions, NCCI edits and PRIVATE PAYER POLICY.

The codes that you are allowed to submit depend on all of these. My point is that you need to get to know your insurance payers and what they allow. You can't just follow Code-X only.