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Wiki How would surgeon bill for a Rotationplasty?

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lenamarie73

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One of our Orthopedic Oncology surgeons is performing this procedure (aka Van Nes rotationplasty) and I would like to help her out with CPT codes before the procedure.

Thanks in advance for any insight on this.
 
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There is so much going on. It's a question of breaking it down into individual parts like the osteotomies, somewhat of amputations, radical resections, disarticulations, the soft tissue and other work, etc or using one unlisted code. There is no one code to describe this. It may be a matter of working with your provider(s) and payers individually to come to agreement on using unlisted codes and/or a combination of unlisted and existing CPT to bill for this. It has to be put into the contracts.
When I worked with an orthopedic oncology, hip preservation, complex joint reconstruction surgeon he would go to the individual payers and we would work out coding for the novel and other unlisted procedures he was performing to have it put in contracts on how this would be billed and the reimbursement.
It takes teamwork and partnership between the revenue cycle side and coding along with the providers if your practice is doing very specialized, complex cases with no codes. Otherwise, reimbursement will suffer and the providers will not be getting credit for their work. Someone who is not up to speed could code these type procedures incorrectly. I have seen where coders didn't understand and used incorrect codes for highly complex procedures and the reimbursement was totally off.
Whoever is in charge of coding, the revenue cycle director, surgeon and possibly the C-level team need to be involved in this, it shouldn't be left up to staff coders to try and figure it out with this type of case.
 
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adunlap23 said:
I'm wondering if this is the same procedure Dr. Pechacek has discussed...
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Yes, somewhat the same type of procedure, not exactly the same as the Van Nes. He was saying sort of the same thing as me though. You can try to piece together multiple existing CPT codes to try and code it but that's not a good plan. There has to be a process and policy in place for coding and billing to follow. Another option is to do it on a case by case basis and work with the payer pre-surgery through auth but that is a lot of work. Better if you can get a carve out for the contract ahead of time. These are very complex and specialized procedures that are not going to be done at a general ortho office. A provider would have to think about also working with the facility to make sure everyone is on the same page with coding/billing.
 
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