Wiki Negotiating reimbursement for unlisted procedure: Endoscopic Gastrocnemius Release (EGR)

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Has anyone had any luck in negotiating reimbursement for Endoscopic Gastrocnemius Release (EGR), reported with code 29999: Unlisted procedure, arthroscopy?
The process is the same for all unlisted codes when negotiating for reimbursement so the specific procedure is not as important as the negotiation process, and a win is a win.
In my 25-year career, I know that reimbursed unlisted codes are rare but possible.

There is a code for the open procedure: 27687: Gastrocnemius recession (eg, Strayer procedure). But that cannot be used for the endoscopic version.

I've been assembling tools to help clinicians establish a fair price and negotiate payment with the carriers and posting them for free on the website: www.ioectr.com. Click on the "Other Procedures Tab" for the unlisted code documents. Any advice or feedback is welcome! I created a sample Spreadsheet to calculate the values based on a comparison code but what I really need is an "official" one from a professional medical association or from someone who has successfully contracted reimbursement.

In addition, this procedure could be performed in the office, or Office-Based Surgical Suite (OBSS), which is a separate issue. I also have information for managers and providers on how to set up an OBSS.

Jeffrey P. Restuccio, CPC
 

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  • unlisted code reimbursement overview.pdf
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  • unlisted code Decision Tree GRAPHIC SEP 10 2021 B.pdf
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