Expert: Vascular bone graft

cmedina

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Hello All,
I need an expert on this one. Doctor performed a Non-union repair w/radial styloidectomy and vascualrized bone graft, left scaphoid. I've researched everywhere to verify if they are inclusive & can't find anything. My question is can I bill 25440 & 25430-59 or is there another way.

Thanks in advanced for any help.
 

mbort

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The code 25440 includes obtaining the graft therefore you should not be billing the 25430.(of course this opinion is rendered without seeing the op note).
 

cmedina

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I understand that the bone graft is included but CPT 25430 is the insertion of vascular pedicle into the carpal bone. That's exactly what the OR states, now per Medicare CCI edit this is billable with the -59. And there is no mention of this being inclusive per the AAOS Codex.
The OR states:
"No fracture; Nonunion taken down & resected; Vascularized graft was taken with cancellous bone packed in. This was held with a K-wire. Under direct supervision it was placed in the bone."

Now, with this being an insertion not a graft can I still bill it?

Thanks
 

mbort

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I would still stick with my original comment, I think it is all inclusive. I would chose one or the other but not both codes.
 
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