Wiki CMC arthroplasty with tendon graft

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shortee3810

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Recently received denial from Humana stating 20924 is bundled with 25447. Please note below pasted information from Orthopedic Coder's Pink Sheet 2015 regarding tendon graft with CMC arthroplasty. Humana denial reads it may be reported if harvested or the procedure is done contralateral or same session and appended with modifier 59. In reading the the below pasted pink sheet info it does not indicate tendon graft to be done contralateral. Unless there is a recent change that I'm not aware of please advise. Thank you


If the surgeon documents an excisional arthroplasty, with insertion of autograft as an interpositional spacer in place of resected bones and the tendon graft is harvested from a different site through a separate incision, the AMA states that you may report 20924 for the graft harvest. However. if the surgeon uses a local tendon such as the flexor carpi radialis (FCR) tendon or the abductor pollicis longus that is obtained through the same incision as the arthroplasty, that service would be included in code 25447, CPT Assistant states.
 
I have seen 26480 reported with 25447 for some of these but it depends on what was done and the op note specifics and is for transfer.


  1. Incorrect reporting of first CMC excisional arthroplasty and associated services
Hand surgeons use a range of techniques for first carpometacarpal (CMC) excisional arthroplasty. Whether excisional arthroplasty is performed with an interposition tendon graft, tendon suspension, or allograft tightrope, all methods are reported with CPT code 25447, Arthroplasty, interposition, intercarpal or carpometacarpal joint.

When a flexor carpi radialis tendon graft is harvested in the forearm for arthroplasty stabilization, the American Society of Surgery for the Hand (ASSH) has instructed its members to utilize code 26480 for reporting Transfer or transplant of tendon, carpometacarpal area or dorsum of hand without free graft, each tendon based upon directives published in “CPT Assistant.” This code represents the location of the tendon placement, not the location of harvesting. Because there is no National Correct Coding Initiative (NCCI) edit between codes 25447 and 26480, it is not necessary to use modifier 59 for this code combination. Multiple procedure modifier 51 would be used with code 26480 because it has a lower relative value than 25447.

Removal of the trapezium or trapezoid is included in CPT code 25447. If a second carpal bone is fully or partially excised, use of CPT code 25210 also is supported, but the code must be appended with modifier 59 to explain that the provider is not using it to report the first carpectomy, thus unbundling the arthroplasty service.
 
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