Wiki Rotator cuff repair with a Bioinductive Implant

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yvetteprater

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My doctor has been doing this surgery for a while. I was never sure if I could bill for the procedure in addition to the cuff repair. Op note reads "Given the large to massive traumatic nature of the tear in this 60-year-old female, with several risk factors for failure of the repair, she was felt best treated with additional fixation utilizing a Bioinductive implant. We selected the medium Regeneten implant which fit appropriately. This was placed over the central portion of the repair construct. It was fixed medially with multiple resorbable staples followed by two bone anchors laterally. This anatomically reduced and solidly fixed the implant back to the cuff repair completing the overall repair construct." Any suggestions or help on coding would be appreciated. I looked back and found a thread regarding this but I didn't quite understand exactly what they were billing.
 
yvetteprater said:
My doctor has been doing this surgery for a while. I was never sure if I could bill for the procedure in addition to the cuff repair. Op note reads "Given the large to massive traumatic nature of the tear in this 60-year-old female, with several risk factors for failure of the repair, she was felt best treated with additional fixation utilizing a Bioinductive implant. We selected the medium Regeneten implant which fit appropriately. This was placed over the central portion of the repair construct. It was fixed medially with multiple resorbable staples followed by two bone anchors laterally. This anatomically reduced and solidly fixed the implant back to the cuff repair completing the overall repair construct." Any suggestions or help on coding would be appreciated. I looked back and found a thread regarding this but I didn't quite understand exactly what they were billing.
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Hello,

I code for a doctor who uses Regeneten bioinductive implants along with arthroscopic rotator cuff repair. We bill for the rotator cuff repair (29827) for the physician charges, and the facility bills for the regenten patches. We used to add modifier -22 to account for the extra work involved with the regeneten placement, but have been instructed by various payors not to do that.

I hope this helps.
 
So for the profee side. would you even capture the regenten implant? I code for the 29827 & 29828 and the HB coder wants to add a 23929 unlisted code. So on the profee side are we able to capture this as well?
 
ealvarez113@hotmail.com said:
So for the profee side. would you even capture the regenten implant? I code for the 29827 & 29828 and the HB coder wants to add a 23929 unlisted code. So on the profee side are we able to capture this as well?
Click to expand...
You cannot separately capture this work. Arthroscopically, it is all included in 29827. Done mini-open, it would be considered a reconstruction (23420). A few insurances will allow you to bill out Regeneten as a separate line item on the facility side but there is no reimbursement on the ProFee side.
 
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