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

Per CPT Assistant 2019, Question: A patient presents with a stress injury resulting in a bone marrow lesion of the medial tibial plateau. The physician performs a percutaneous arthroscopically assisted reinforcement of the stress injury using an arthroscope for visualization and for injection of calcium phosphate ( or other bone void filler) into the medial tibial plateau bone defect. The cannula is manipulated within the involved area to maximize reinforcement of the medial tibial metaphysis. A total of 10 mL of calcium phosphate is injected. Would it be appropriate to report CPT code 29855? Answer: There is no specific CPT code that accurately describes this procedure. Therefore, CPT code 29999, Unlisted procedure, arthroscopy, should be reported for the procedure described in the question. Code 29855, Arthroscopically aided treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed (includes arthroscopy), is appropriately reported for arthroscopically aided management of intra-articular fractures of the tibial plateau that typically require reduction of the fracture and/or internal fixation. This code is not appropriate for injection of calcium phosphate into a bone-marrow lesion that does not require a reduction .

Per CPT Assistant 2018, Question: A patient developed a medial femoral condyle insufficiency fracture. To repair the defect, the surgeon utilized fluoroscopic visualization and an intraosseous device to inject 5 ml of calcium phosphate into the defect of the medial femoral condyle via small poke holes. Would it be appropriate to report code 27509 for this procedure? Answer: No, it would not be appropriate to report code 27509, Percutaneous skeletal fixation of femoral fracture, distal end, medial or lateral condyle, or supracondylar or transcondylar, with or without intercondylar extension, or distal femoral epiphyseal separation, for this procedure. The surgeon is filling an osteoporotic area of bone with bone filler and not performing skeletal fixation of the fracture. Consequently, the procedure that was performed does not fit the description of an existing specific CPT code and would instead be reported with code 27599, Unlisted procedure, femur or knee.

From my understanding, when no reduction of the fracture is performed and/or no internal fixation is applied, an unlisted code (CPT 29999 vs 27599) would be reported for the ACP injection.
If the fracture is reduced or internal fixation is applied, the appropriate fracture care code would be reported. The ACP injection would basically be a free service.

**Check payer policies to see if ACP injections are investigational/experimental, as many payers do.
 
Look at 0707T - Injection(s), bone substitute material (eg, calcium phosphate) into subchondral bone defect (ie, bone marrow lesion, bone bruise, stress injury, microtrabecular fracture), including imaging guidance and arthroscopic assistance for joint visualization. This is a CAT III code effective 1/1/2022. For dates of service before 2022, CPT Assistant stated to use the unlisted code for the relevant body area - e.g. 28899 - Unlisted procedure, foot or toes - for subchondroplasty of the calcaneus.
 
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