1. T

    Wiki Aetna meniscectomy policy

    Has anyone seen any movement on Aetna's extremely restrictive policy on meniscectomy coverage?
  2. A

    Wiki Billing a bilateral knee xray with a unilateral knee xray

    Ex: When a provider orders a bilateral xray of the knees AND 3 additional views of the right knee, per CCI guidelines we are not allowed to bill the bilateral xray with a unilateral xray code. What we have been doing is removing the charge for the bilateral xray (CPT 73565) and instead using...
  3. T

    Wiki Outpatient knee

    I need any help I can get on this one. Dr performed 3 procedures that I cannot find codes for. The ORIF he is dictating comes back as CPT 27540 but that is an Inpatient only code and we are an ASC. POSTOPERATIVE DIAGNOSES: 1. Left knee tibial tubercle avulsion fracture. 2. Periosteal...
  4. F

    Wiki ORIF osteochondral lesion of the knee

    Please help! I'm leaning towards an unlisted code, but would appreciate input. There was no allograft or autograft, just fixation of osteochondral lesion. The note reads: Postop Dx: Right knee medial femoral condyle osteochondral lesion, displaced Operation performed: Right knee arthroscopy...
  5. K

    Wiki Help with coding for blood clot augmentation

    How would I code arthroscopic repair of lateral meniscus tear, right knee, with blood clot augmentation? My doctor has chosen 29882 with 20926. Would this be accurate?
  6. D

    Wiki Medial Parapatellar arthrotomy help!

    Can anyone help me with coding for this surgery? I'm very stuck and the codes the doctor wrote down do not seem to match what was actually done. Thank you in advance! PREOPERATIVE DIAGNOSIS: Left knee patella chondral defects secondary to patella subluxation episode. POSTOPERATIVE DIAGNOSIS...
  7. D

    Wiki Help with arthroscopic stress fracture coding!

    Our doctor often performs stress fracture repairs using Knee Creations calcium phosphate cement and I have trouble with coding this. In this case, it seems he is doing it arthroscopically or percutaneously, and he likes to try to code it as 27509. I'm not sure I feel this is the appropriate...
  8. J

    Wiki Standing knee (73565) and 2 views one knee (73560)

    When a patient has both a standing knees xray (73565) and then an additional 2 views of right knee (73560), I know that you would combine the views for the right knee creating 73562-RT. However, do you then also bill 73560-59-LT for the left knee?? -Julie
  9. R

    Wiki Chondroplasty PCS- repair or excision?

    Hello everyone! I am taking the General PCS code set online program and one of my practice questions is a chondroplasty. I read through the report and selected the root operation "excision". But my answer sheet coded it to "repair". Can anyone explain how and where I went wrong with my...
  10. A

    Wiki Cpt 20610 - Is anyone having issues

    Is anyone having issues with getting paid for 20610 from United, Humana or Aetna?? Looks like they only have knee Dx codes listed on their policy, but not taking into consideration of the other major joints.
  11. M

    Wiki What are you using for icd 10 code for Psuedogout LT knee?

    Hello, Any suggestions for psuedogout LT knee? Thanks in advance! Mickie
  12. J

    Wiki UHC and knee xrays

    Is anyone else having issues with United Healthcare (Community Plan and United Healthcare Shared Services) denying E&M codes inclusive to knee xrays (specifically 73560)? We are an orthopaedic group that frequently performs knee xrays on patients. I have contacted both insurance carriers...
  13. K

    Wiki Co-Surgeons -- Modifier 62

    Hello all, I'm having a hard time distinguishing the proper use of modifier 62. In almost all Medicare articles they constantly state "when two surgeons (different specialties) perform a surgery...." that makes me think that they have to be from two different specialties. However when they give...
  14. T

    Wiki injection only to be billed out?

    I don't see anything coming out to be able to bill the E/M with the injection. any thoughts?? I am still trying to understand and learn the E/M. its fairly new to me. 1. Right knee pain. HPI: Appointment type: Established patient - Established problem Patient returns for his right...
  15. D

    Wiki coding question 29880 and 29877

    cpt 29877 and 29880 I know should never be billed together, however when the dr. does a shaving in a different part of the knee, would I be able to append modifier 59?
  16. M

    Wiki Diagnosis Coding - 3 degenerative joint disease

    I am working on Practicode. I have a note which says that the pre-op diagnosis is a torn lateral meniscus of the right knee. The post-op diagnosis is grade 3 degenerative joint disease of the primary knee. Am I supposed to code both in this case? Also, I have another question. Am I supposed to...
  17. M

    Wiki Need DX code for ACL Deficient Knee

    Hello, Does anyone have a suggestion for ACL Deficient Knee (right)? Not sure if M23.51 is accurate. Thank you in advance! Micki
  18. L

    Wiki Bilateral Knee xrays

    Did something change with coding bilateral knee xrays? We use to bill 73560-50, but it looks like the 50 modifier is not longer allowed.
  19. P

    Wiki djd knee dx

    question: report states "DJD left knee"... I have been coding as M17.12, but my supervisor says that is should be M17.9 for unspecified. I disagree, on the thought that it says left knee, and if it does not state either primary or secondary, it defaults to primary.....any help would he...
  20. G

    Wiki knee "popped"

    Is this coded chronic or acute? Ex: A patient's knee popped while walking. Now he is in pain. He is coming to our facility for an MRI. Thanks
  21. C

    Wiki Meniscal tear

    The patient is a 66-year old male who had sustained an injury to his right knee when he stepped into a hole on the sand on the beach. This resulted in significant and persistent billow-sided joint pain. While he had a history of previous knee problems, he had not had this level of symptoms...
  22. M

    Wiki Coding Question - Chondromalacia

    1. LT Knee Chondromalacia of patella type 2 to 3 2. Extensive Synovitits 3. Posterior third medical meniscal with type 3 to 4 chondromalacia on the medical femoral condyle 4. Loose Body 1. Complete Synovectomy of the superior patella pouch, inferior patella pouch, medial gutters and lateral...
  23. Y

    Wiki Could someone help me code this PLEASE and THANKS!!!!

    Post op dx code: rt patella dislocation, recurrent Procedure performed: medial patellofemoral ligament reconstruction, lateral, and distal patellar tendon oversew and transfer Assistant: _______APRN. A skilled pair of hands was required for neurovascular protection, retraction, and proper...
  24. C

    Wiki Merchant view knee x-ray

    Just curious what code should be used for the Merchant view knee x-ray. We had been using 73565, as it is one film of both knees. We are now questioning ourselves as that specifically states standing, AP view. Should it actually be 73560, since it is only one film? Or 73560-50 since it is one...
  25. C

    Wiki MCL, LCL, and MPFL Reconstruction

    One of our physicians did arthroscopic ACL and PCL reconstructions, and Open MCL, LCL, and MPFL reconstructions. He is wanting to code 29888, 29889, and 27427 x3. Can we do this? Since 27427 doesn't state "per ligament" doesn't that mean we can only bill it once per knee? Any help would be...
  26. B

    Wiki Need Help! IT band tendinitis and injection

    I would like to hear what code others are using for this diagnosis. I see this regularly and treatment is often an injection (20551) at the hip or knee. CMS does not have an LCD for this and my injections are denied. Any suggestions? Thanks
  27. C

    Wiki Examination Under Anesthesia

    I need some help on of our physicians did an IM Nailing of the Tibia, ORIF of Bimalleolar Fx, and an "exam under anesthesia" of the knee. I got the first 2 but am having trouble on the exam under that even billable? If so, what code would I use? Here is what is...
  28. C

    Wiki Laxity testing

    Some of out providers are doing Laxity Testing on knees here in the office. My fellow biller and I have always been under the impression that this is just part of the exam, but now one of the physicians is stating it is billable...does any one know what the code would be and if it is payable in...