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Wiki Medicare Part B and Unlisted CPT code 27299

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chightower@tcortho.com

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The below is the procedure that was performed. The surgeon used CPT 27299 (unlisted) and compared it to CPT 27385. Medicare has denied the claim as an invalid procedure and there are no appeal rights. Can anyone have any ideas on what to do to get the claim paid?

We went through an old posterior approach to the hip cutting sharply down through skin. We isolated the fascia. It looked like some of the fascia or the sutures might have come loose and this stretched out the fascia, so we followed the fascia down and then also opened up the fascia and looked underneath and looked like also some of the posterior hip musculature, short external rotators, and the gluteus had have both kind of retracted back a little bit, so we gently excised some of the scar tissues, irrigated the wound, place a drain. I repaired some of the short external rotators up to the trochanter to some of the scar tissue on the trochanter with Vicryl. I then used #2 Fiberwire to pull the gluteal muscles up to the IT band posteriorly and it filled the gap very nicely. I then pulled some of the rest of the subcutaneous fat and the rest of the fascia up together and again pulled it together very nicely and gave a nice layer for it.
 
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Was the proper procedure followed for reporting an unlisted code to Medicare?
Was the unlisted code used correctly, should it have been reported? What else was done? Was this a glute repair done while in there for a dehiscence or disruption of a prior surgery still in the global, like THA or femoral fracture? Was it an infected surgical wound?

Example of process for unlisted: https://med.noridianmedicare.com/we...rs-solutions/unlisted-procedure-and-noc-codes
 
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You could easily get away with 27396 for this, as you've essentially done a muscle transfer in the thigh. The op note is poor and may need to be amended in light of the CPT code you'd use for it to clearly denote that you took gluteal musculature and rerouted/transferred it to the IT band.
 
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