Category: Orthopaedics

Stem Cell Implant Knee Osteoarthritis
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Stem Cell Implant Knee Osteoarthritis

September 19, 2019 Question: Our surgeons are harvesting adipose tissue and creating an injectable implant that they are injecting in the knee for treatment of osteoarthritis. We want to verify that our use of an unlisted CPT code is correct. We have some payors who do reimburse for this service; others require the patient to...

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. ...

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Tips and Best Practices for Using Code-X

Tips and Best Practices for Using Code-X AAOS Now – June 2019  by Cheryl Toth After speaking with Michael Marks, MD, MBA, and Margaret Maley, BSN, senior consultants from KarenZupko & Associates, Inc., (KZA) about the most valuable features of Code-X in part one, Cheryl Toth, MBA, spoke with Madelaine Reese, senior product manager of online learning...

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Coding Experts Weigh in on the Value of Code-X

Coding Experts Weigh in on the Value of Code-X AAOS Now – May 2019  by Cheryl Toth If you are looking for an electronic tool that makes code selection easier and gives your practice powerful data for reducing denials, strengthening appeals, and validating plan payments, the Academy’s Code-X software tool is a good choice. Code-X is a...

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...

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