Question Intraosseous bioplasty

hmlsmith

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Hello,
The Op Report indicates (after performing an arthroscopic meniscectomy on the same knee) "...All instruments and trocars were then removed. We then isolated a couple of spots on the medial femoral condyle with a large bore needle and injected a combination of demineralized bone matrix and allograft...mixed with ACP that was injected in two different areas of the medial femoral condyle."
Although there is no documentation of an incision indicating an open procedure, Doc states that intraosseous bioplasty should be billed as an ORIF while I believe it should be an unlisted arthroscopic CPT with comparison to CPT 29855.

I am unable to find any documentation to support billing as an arthroscopically aided unlisted CPT. Any help would be greatly appreciated.
Thank you!
 
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Never mind on 36680. I looked at that some more, and that is putting the needle into the canal for an infusion into the bone marrow. Not what is happening here at all. As far as your doctor wanting an ORIF, that requires and incision and exposure of the bone to directly visualize reduction of a fracture. That is not happening here either. I need to get the bottom of this as well, but I suspect Unlisted is where we are this year.
 
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One last thought, it won't be an Unlisted Arthroscopy. He did after the the scope was done. It will be a regular code for the artho menisectomy, and then whatever we come up with for the injection is as an addtional procedure.
 

hmlsmith

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Based upon the limited information I can find on the topics, it appears that what is was termed intraosseous bioplasty is actually an ACP/PRP injection - which is not separately payable when performed with another procedure OR is deemed experimental by the majority of payers (CPT 0232T).
This procedure is very similar to subchondroplasy, which is usually performed with arthroscopy, where calcium phosphate is injected into the defect. Subchondroplasty codes to 29855-6 for tibial plateau or unlisted 29999 for femoral condyle.
Is the difference between subchondroplasy and intraosseous bioplasty (ACP/PRP injections) basically only the substance being injected?
These procedures are so similar yet one seems billable and the other is not...?
 

fwnewbie

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Those injections aren't considered a mosaic procedure are they? I guess I thought this because he injected bone graft materials instead of prp.
 
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