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orthopedic coding

  1. B

    Perform a Sacrococcygeal Injection? Use 20605

    I've been trying to figure out how to avoid rejections from payers who assume that joint injections always come with a laterality modifier. What advice do we have for injections that are strictly mainline? Sacrococcygeal joints are not bilateral and they are not on either side of the body...
  2. J

    Hardware Removal Inclusive denial to Tenolysis

    HI-- I billed the following codes 20680, 25295, 26445. The insurance will only pay for the hardware removal and bundling the other procedures as per the NCCI Chapter 1 ", “A provider/supplier shall not unbundle services that are integral to a more comprehensive procedure". Does this mean I...
    • jhaleycoder
    • Thread
    • hand coding hand surgery hardware removal insurance denial optum ortho orthopedic orthopedic coding orthopedic surgery tenolysis
    • Replies: 2
    • Forum: Orthopaedics
  3. H

    CPT 28485 proper way to bill multiple units

    Hello, I could really use some advice on the proper way to bill multiple units of CPT 28485-LT. I billed: 28485-LT 28485-XS-76- LT 28485-XS-76-LT Outcome: Medicaid paid the first two lines and denied the 3rd as a duplicate. Would it be appropriate to bill CPT 28485-LT, 28485-XS-76-LT (2...
  4. J

    Hand Surgery Help-- Finger/ Hand Tenolysis surgery

    Hi-- If anyone could please help me. Aetna has denied the surgery as Operative Report does not support. All CPT codes have been denied. The operative report below was sent to Aetna. I am not sure if I am missing something. The CPT codes billed are 25295/59, LT (2 units), 26445/51,F1, and...
    • jhaleycoder
    • Thread
    • hand coding hand specialist hand surgery ortho help orthopedic orthopedic coding orthopedic surgery
    • Replies: 2
    • Forum: Orthopaedics
  5. J

    Dermal Allograft with Rotator cuff tear

    What code do you use for a human dermal allograft performed with an arthroscopic rotator cuff repair? CPT 15777 is for the trunk or breast, so should CPT 17999 be used or is it bundled to the repair?
    • jhaleycoder
    • Thread
    • ortho orthopedic coding orthopedic surgery shoulder shoulder arthroplasty shoulder coding
    • Replies: 1
    • Forum: Orthopaedics
  6. J

    UHC denial Reverse total shoulder

    Hi Everyone-- I coded the OP note below as 23472 and 23405. UHC is stating that the CPT codes billed are incorrect. I feel like I am going crazy with UHC. Am I missing something? If someone could quickly review. We have have appealed twice. Procedure: 1. Right reverse total shoulder...
    • jhaleycoder
    • Thread
    • denials uhc optum ortho help orthopedic coding shoulder arthroplasty shoulder coding
    • Replies: 4
    • Forum: Orthopaedics
  7. K

    Modifier Help ORIF Tibiofibular joint and Bimalleolar

    So, I am coding this surgery below, and I need a little modifier help. I have come up with 27829 and 27814 together. How would you bill this out? Thank you for any help you can give me. PREOPERATIVE DIAGNOSIS: 1. Left displaced bimalleolar ankle fracture. 2. Left distal tibiofibular joint...
  8. N

    27570 - Manipulation of knee joint under general anesthesia

    Our Orthopedic surgeon recently received an EXL audit on behalf of Medicare Plus Blue for a Manipulation of knee joint under general anesthesia (CPT 27570). Their audit said "After reviewing the medical documentation CPT 27570 was denied based on CPT guidelines, the submitted documentation does...
  9. O

    Staged revision of arthroscopic ACL

    One of our providers is performing an arthroscopic bone grafting of the femoral and tibial tunnels as the first stage of the revision with an arthroscopic partial medial meniscectomy. She is wanting to bill out 29881, 27356 & 27638; we have searched and are suggesting 29881 with 29999(compared...
    • OrthoTOC
    • Thread
    • arthroscopic arthroscopic knee orthopedic coding orthopedic surgery
    • Replies: 2
    • Forum: Orthopaedics
  10. W

    Coding Lisfranc Dislocations by Primary Arthrodesis

    Good afternoon, Our practice has recently had several Lisfranc surgeries and I wanted to seek out advice to ensure we were billing them correctly. Any responses to either of my questions for these types of surgeries would be greatly appreciated! One of the recent surgeries involved a Lisfranc...
  11. E

    Defining radical in 26145

    Hello, I am looking for help in defining what constitutes a Radical Tenosynovectomy and when to use 26145. Does the surgeon need documentation of pathological tenosynovium for code 26145? Thank a You in advanced, Eva Wade CPC-A
  12. T

    Radical Resection Help

    Hello, I am coding for an orthopedic oncologist that has performed a radical resection of a soft tissue sarcoma located in the right forearm that I am needing some advice on. The surgeon resected the sarcoma as well as part of the ulna that was underneath the sarcoma. My first thought was to...
  13. T

    Radical Resection Help

    Hello, I am coding for an orthopedic oncologist that has performed a radical resection of a soft tissue sarcoma located in the right forearm that I am needing some advice on. The surgeon resected the sarcoma as well as part of the ulna that was underneath the sarcoma. My first thought was to...
  14. L

    Use of CPT 15777

    CPT 15777: Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Within the notes for this code it states when using a biological implant for soft tissue reinforcement in areas...
  15. S

    Lower Back Pain Code

    I encounter this interesting DX yesterday & I want to get your opinion on it: LBP [lower back pain] c̅ L3-L4 levoscoliosis, c̅ (R) radiculopathy + retro/anterolisthesis How would you code it? And why those codes?
    • scalles0
    • Thread
    • levoscoliosis lower back pain orthopedic coding radiculopathy
    • Replies: 2
    • Forum: Diagnosis Coding
  16. S

    excision of palmaris profundus tendon...help!

    Hi, I am hoping someone can help me with my coding dilemma...during a typical Carpal Tunnel release the surgeon noted that there was an accessory tendon draped over the median nerve and defined it as a the palmaris profundus tendon. He excised this tendon. I am hoping someone can help me...
    • stephpatschorke
    • Thread
    • carpal tunnel release orthopaedics orthopedic coding orthopedics palmaris profundus tendon
    • Replies: 2
    • Forum: Orthopaedics
  17. M

    Loose bodies not in Knee Joint

    I hope someone will be able to help me. Lately surgeon's are documenting: "There were diffuse grade 2/3 articular cartilage changes from the medial femoral condyle. There was a radial tear involving the posterior horn and the medial meniscus near the root attachment along the medial aspect of...
  18. M

    Excision of Osteophyte from DIP 26080 vs 26236 vs 26210

    Hello, I would greatly appreciate another coder's opinion on how they would code the following op report? A longitudonal incision was made from the nail fold proximally in the midlateral line after elevating the upper nail fold from the nail plate with a freer elevator. A full thickness skin...
    • MI_CODER
    • Thread
    • hand coding interphalangeal joint orthopedic coding
    • Replies: 3
    • Forum: Orthopaedics
  19. K

    Distal Bicep Tendinitis coding

    I am new to orthopedic coding, still learning. Can anyone help? Pt has LT Distal bicep tendinitis but I only see an ICD-10-CM code for Proximal bicep tendinitis (M75.22--Bicipital tendinitis, left shoulder) After searching I found a site that suggests using M70.32 (Other bursitis of elbow, left...
    • Kaidachi
    • Thread
    • bicep tendinitis ortho specialty coding orthopedic coding
    • Replies: 1
    • Forum: Diagnosis Coding
  20. A

    What is Correct CPT for Laminectomy with Foraminotomy

    Hello! When a Laminectomy is performed with Foraminotomy (NO Facetectomy is done) I am having a difficult time determining the correct CPT code. CPT 63047 implies that all 3 Laminectomy, Foraminotomy AND Facetectomy must all be performed in order to capture so I don't feel I can use this CPT...
  21. J

    Shoulder Coding Question

    I am confused as to if/how to code for a open RC Repair when the Surgeon attempted to repair the Rotator Cuff but after attempting it was found to be irreparable. Any information would be extremely helpful and graciously accepted. Thank you!
    • Jennae929
    • Thread
    • orthopedic coding rc repair shoulder coding
    • Replies: 1
    • Forum: Orthopaedics
  22. T

    Experienced Orthopedic Coder/Auditor for Full Time Remote Position

    I have over 20 years of orthopedic coding experience and am currently seeking a full time remote position. I am experienced in Trauma,multi-trauma procedures, modifiers, Foot/ankle procedures, Arthroscopies, Hand procedures, medical necessity denials, unlisted procedures (subchondroplasties)...
  23. T

    COSC Needed for Onsite Physician Ortho Coding Audit in the Syracuse NY area.

    Looking for an immediate, experienced COSC that lives near the Syracuse, NY area to perform on site orthopedic audits of office and surgical procedures as well as E&M visits. Must have current in depth knowledge of orthopedic surgical coding and compliance rules for billing. Knowledge of...
    • thensel
    • Thread
    • cosc ortho orthopedic orthopedic coding
    • Replies: 0
    • Forum: Orthopaedics
  24. M

    Orthopedics

    Hel with Orthopedic Surgery Coding Request 1. Right hand crush 2. Extensor pollicis longus tear 3. Extensor digitorum tear to the ring and small fingers 4. Extensor carpi ulnaris tear 5. Comminuted distal ulnar fracture 6. Distal radial ulnar joint disruption and dislocation 7. Perilunate...
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