Category: CC-Orthopaedics

How do you define “No Qualified Resident Available”?
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How do you define “No Qualified Resident Available”?

August 8, 2019 Question: Our physicians utilize residents during surgery but we have a discrepancy in what is considered a “Qualified Resident”. Some physicians consider a resident qualified to assist day 1 of their residency rotation, while others consider only 4th and 5th year residents as qualified to assist. Can you guide us to documentation...

Why Did I Receive This Denial?
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Why Did I Receive This Denial?

July 25, 2019 Question: Our surgeon performed a meniscectomy on a Medicare beneficiary.   During the 2nd post-operative visit the surgeon started a series of Hyaluronate injections in the operative knee for a diagnosis of osteoarthritis.  The claim form was submitted with a modifier 79 and a diagnosis of osteoarthritis.   Our Medicare carrier denied it as...

Superior Capsular Reconstruction
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Superior Capsular Reconstruction

July 11, 2019 Question: What CPT codes do I use for comparison when the surgeon performs a superior capsular reconstruction? I know I have to use an unlisted code. Answer: Great job in knowing that this procedure is reported with an unlisted code. The AAOS recommends comparing this procedure to CPT codes 29827 and 29806. ...

Subscapularis and Supraspinatus Repair
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Subscapularis and Supraspinatus Repair

June 20, 2019 Question: I perform an arthroscopic repair of the supraspinatus and subscapularis tendons through separate incisions/portals.   May I report CPT code 29827 twice? Answer: CPT code 29827, arthroscopic rotator cuff repair is reported one time regardless of whether one or all four tendons are repaired.  Consider adding modifier 22 for the additional complexity...

Laminoplasty
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Laminoplasty

April 25, 2019 Question: My surgeon did a C2-C7 laminoplasty and reconstructed with mini-plates. What code should I use?  Answer: This procedure is reported using CPT 63051 (Laminoplasty, cervical, with decompression of the spinal cord, 2 or more vertebral segments; with reconstruction of the posterior bony elements (including the application of bridging bone graft and...

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