KeriTouch Procedure - Dual Mobility Trapeziometacarpal Prosthesis - Help!

[Sdjohnson8725]

One of our orthopaedic surgeons is planning on performing the KeriTouch procedure with the dual mobility trapeziometacarpal prosthesis. His office is trying to obtain prior auth and were told the CPT code for billing is 26989 (Unlisted procedure, hands or fingers), but with it being an unlisted code they're having a hard time obtaining an auth. Could this procedure be billed with 25445 (Arthroplasty with prosthetic replacement; trapezium)? I'm not sure if this specific procedure does more than 25445, but I was also thinking they code bill 26989 with 25445 as a reference with an additional note on the claim.

Any thoughts/help is appreciated!

 

[NRaizman]

This needs to be coded with the 1003T Category 3 CPT code, which goes live on January 1.
It will be contractor priced, so good luck with that.
N.

 

[Sdjohnson8725]

This needs to be coded with the 1003T Category 3 CPT code, which goes live on January 1.
It will be contractor priced, so good luck with that.
N.

Thank you! I was recently made aware of the new Cat III code for it. The procedure was actually performed today.

 

[NRaizman]

Code would not be live then and you'd be -fine- coding the 25445.
N.

 

[swallace1]

One of the surgeons I work with just started billing for this, and we plan on coding 1003T. Does anyone have any experience with reimbursement, and what supporting documents need to be included?
The only reference I could find recommended sending; H&P, Labs/Imaging, Office Visits, OP note, Full text peer reviewed articles and society guidelines.

I wonder if we should include all that information, and if yes, what peer reviewed articles and society guidelines are you including with the claim?

Lastly, are surgeons being paid for this?

 

[NRaizman]

This is a complex issue.

If you are billing CMS, then you should get paid based on contractor pricing, and there is a pass-through for the device.

If you are trying to do this with a private payor, you would really want to get this pre-authorized and confirm reimbursement prior to performing the surgery, and also confirm implant pricing, as it will be included in the facility fee and not separately reimbursed. GIven the very high implant cost and distinct possibilty that it will not be a covered service, this could be a spectacular money loser for any institution not going through their due diligence.

There are no society guidelines relevant to this. Full text peer-reviewed articles are easy to find. There is one RCT and one meta-analysis available I believe.
Your surgeon will need to help you out with this, and Medartis has reimbursement consultants and a payment team that can get you everything you need.