jovibon110@gmail.com
Networker
Unlisted procedure - what would you use as a comparable code ?
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Wiki Arthroscopic Hip Labral reconstruction
- Thread starter jovibon110@gmail.com
- Start date
Ortho not my expertise, but seems similar to
29916 Arthroscopy, hip, surgical; with labral repair OR
29862 Arthroscopy, hip, surgical; with debridement/shaving of articular cartilage (chondroplasty), abrasion arthroplasty, and/or resection of labrum.
I would be curious about what the "reconstruction" was if not repair or debridement/shaving/arthroplasty/resection. If the reconstruction is more work than a repair, you could compare it, stating it is _____% (you fill in the blank) more work, or possibly with modifier -22.
29916 Arthroscopy, hip, surgical; with labral repair OR
29862 Arthroscopy, hip, surgical; with debridement/shaving of articular cartilage (chondroplasty), abrasion arthroplasty, and/or resection of labrum.
I would be curious about what the "reconstruction" was if not repair or debridement/shaving/arthroplasty/resection. If the reconstruction is more work than a repair, you could compare it, stating it is _____% (you fill in the blank) more work, or possibly with modifier -22.
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Actually, I found this thread from last year with the same question https://www.aapc.com/discuss/threads/arthroscopic-hip-labrum-reconstruction.174365/
I know orthocodergpu knows ortho inside & out, and I personally found it reassuring to see the same 29916 recommendation.
I know orthocodergpu knows ortho inside & out, and I personally found it reassuring to see the same 29916 recommendation.
jovibon110@gmail.com
Networker
I billed the 29916 and the doctor thinks it should be unlisted because it is a lot more work then just doing a repair. I saw that post for unlisted comparing it to 29916 but then you aren’t getting paid for more work. I thought about mod 22. Will have to ask her if that would be an option.
Orthocoderpgu
True Blue
Arthroscopic surgeries take more training and are more difficult to perform than open procedures. So the "comparison" code, whatever that is, should just be a starting point for the insurance company, it's not the final destination. In short I agree with your surgeon. I think adding the modifier -22 to the unlisted code is more than appropriate in this case to help capture the full complexity of this procedure. Years ago I actually worked with the person at an insurance company whos job it was to work unlisted codes and determine their value for payment. Each one received individualized attention. I can only hope that is still the case today.
jovibon110@gmail.com
Networker
I code for ortho doctors and the practice is owned by the hospital. We send an email to Revenue Integrity with the unlisted code and the comparable code and then they send back the amt that we are to charge and the RVU’s. So If unlisted I have to have a comparable code and am not finding any info on what that would be. I was told that you cannot add a 22 to an unlisted code ? I can see putting it on the 29916. I could ask them to figure the amount for the 29916 with the increased amt (22) and use that amt for the unlisted procedure. I believe another coder had them do that. Appreciate the input on my post.
Labral reconstruction is significantly more complex than a labral repair. There is a 2019 CPT Assistant that says these should be billed using an unlisted CPT code, thus not labral repair w/a 22.