Wiki Cartilage graft with tympanoplasty, denied

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LadyT

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I need some help. I have billed CPT 21235 with CPT 69633 because the provider made a separate incision but it is being denied because the ICD 10 does not support the procedure. Should these two CPT codes not be billed together? My google research says it is billed with a separate incision. ANY advice would be appreciated!
 
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LadyT said:
I need some help. I have billed CPT 21235 with CPT 69633 because the provider made a separate incision but it is being denied because the ICD 10 does not support the procedure. Should these two CPT codes not be billed together? My google research says it is billed with a separate incision. ANY advice would be appreciated!
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Here is a copy of an article from Becker's. In the 'old days', we never separately coded fascia or cartilage grafts, even if they were harvested from a separate incision. But in 2008 the AMA came out with advice that said you could separately code it. Doesn't mean the payers will reimburse anything, but you can separately code for it. I would think the membrane tear or hearing loss or cholesteatoma or whatever dx you're using for the tympanoplasty would be sufficient for the graft harvest also, as it is part of the repair.
Hope this helps.
 

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Hello,
per the Coding Desk Reference description of 69633 graft is included even if harvested. I would only bill 69633.
21235 would be for reconstruction of nose or ear with graft
Happy coding!
 
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nickelclaw said:
Beckers is for ASC sometimes the rules are different for surgery centers.
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Nickelclaw, I found a CPT Asst December 2012 that says it is separately reportable if the graft is harvested through a separate incision and when the 'descriptor language' does not specify graft harvest as integral to a service (see below). The descriptor in the CPT book says: Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction. It doesn't say "with or without graft". What do you think? I'm not trying to be difficult, just trying to figure out what's really correct. I realize some sort of material has to be used to cover the perforation. But since the CPT Asst specified this with a 69631, I'm thinking as long as it was from a separate incision, then CPT Asst is saying it can be separately reported?
Thanks for your help.


THEN and NOW: Temporalis Fascial Graft
The March 2007 (p 9) and August 2008 (p 4) editions of the CPT Assistant discussed the reporting of code 69631, Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction, with harvesting of a temporalis fascial graft through the same or separate incision. This information has been updated and the following clarification is provided in this Then and Now.
THEN The March 2007 CPT Assistant indicated that code 69631 includes the work of harvesting the graft material. Therefore, code 69631 should be reported regardless of whether the graft was harvested through the same incision or a separate incision. Therefore, it would not be appropriate to report a separate code for the fascial graft.
NOW The August 2008 CPT Assistant discussed the repair of a tympanic membrane perforation, wherein a graft is harvested from either the temporalis fascia or other locations (ie, vein, periosteum, or conchal cartilage perichondrium). Occasionally, a graft is used from material other than autogenous tissue. If the temporalis fascia graft is harvested through a separate donor incision, the harvesting should be reported separately from the tympanoplasty. The August 2008 coding guidance supersedes the March 2007 CPT Assistant instruction, as it agrees with the general CPT convention that graft harvest is reported separately under these conditions: (1) when obtained through a different incision; and (2) when the descriptor language does not specify graft harvest as integral to a service.
 
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Coding Tip: - Tympanoplasty procedures may require the use of a graft in order to repair the tympanic membrane. The harvesting of the graft does not warrant a separate CPT code if the graft was obtained through the same incision used for access to the tympanic membrane or middle ear. Otherwise, a graft harvest code may be reported.
 
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by same incision means the approach , if the graft is harvested thru that incision it is included, if it is harvested from another separate incision not the approach incision it should pay
 
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