betsycpcp
Networker
I work for a payer and we authorized "Resection Arthroplasty distal radial ulnar joint." The provider listed 25332 on the authorization request, but now the hospital is billing with 25337. I'm not sure either one of those is correct. The procedure is shown on the op report as "Modified Bower resection interpositional arthroplasty distal radioulnar joint."
Description: "Attention was then turned to the distal radioulnar joint where a longitudinal incision was planned and carried out over the 5th dorsal compartment. Full-thickness skin flaps were elevated. Superficial nerve endings were protected. The 5th dorsal compartment was opened on its radial margin. The tendon was displaced. A flap of extensor retinaculum and capsule were then incised just below the level of the TFCC and was detached from its radial attachment including mobilizing of the dorsal capsule. A small Freer elevator was placed over the ulnar head to palpate and expose the ulnar head and inspect the TFCC. The oscillating MicroAire saw was then used to divide the ulnar head along the shaft of the ulna to create a dowel rod configuration. A lamina spreader was placed in the wound and mobilized the ulna to inspect the underneath surface and further resection was carried out. A small rasp was used to smooth and contour the osteotomy. With the capsule fully exposed a suture of 0 Ethibond was placed in the volar capsule and this was then brought up into horizontal mattress fashion through the dorsal capsule and the extensor retinacular flap and was used as an interposition and stabilizing wrap around the resected ulna. The wound was copiously irrigated. Additional peripheral sutures were placed with 3-0 Vicryl. The 5th dorsal compartment was left subcutaneous. The wound was copiously irrigated and the skin was closed with subcuticular 3-0 Vicryl and 5-0 nylon suture."
I saw one suggestion to use 25240 for modified Bowers, but that doesn't seem to cover the whole procedure- just the distal ulna resection. The Coders Desk Reference lay description of 25332 doesn't seem to match what was done, and neither does 25337 (but I know there can be variations so the lay descriptions don't always cover all the ways the procedure can be done).
Anyone know what is normally used for the modified Bowers procedure, and is there any official source, website etc. that backs it up? I see plenty of references online to the procedure, but almost never with a CPT code. This is a workers' comp claim and is subject to audit so I hate to pay without being sure if the coding is correct. Any help is appreciated!
Description: "Attention was then turned to the distal radioulnar joint where a longitudinal incision was planned and carried out over the 5th dorsal compartment. Full-thickness skin flaps were elevated. Superficial nerve endings were protected. The 5th dorsal compartment was opened on its radial margin. The tendon was displaced. A flap of extensor retinaculum and capsule were then incised just below the level of the TFCC and was detached from its radial attachment including mobilizing of the dorsal capsule. A small Freer elevator was placed over the ulnar head to palpate and expose the ulnar head and inspect the TFCC. The oscillating MicroAire saw was then used to divide the ulnar head along the shaft of the ulna to create a dowel rod configuration. A lamina spreader was placed in the wound and mobilized the ulna to inspect the underneath surface and further resection was carried out. A small rasp was used to smooth and contour the osteotomy. With the capsule fully exposed a suture of 0 Ethibond was placed in the volar capsule and this was then brought up into horizontal mattress fashion through the dorsal capsule and the extensor retinacular flap and was used as an interposition and stabilizing wrap around the resected ulna. The wound was copiously irrigated. Additional peripheral sutures were placed with 3-0 Vicryl. The 5th dorsal compartment was left subcutaneous. The wound was copiously irrigated and the skin was closed with subcuticular 3-0 Vicryl and 5-0 nylon suture."
I saw one suggestion to use 25240 for modified Bowers, but that doesn't seem to cover the whole procedure- just the distal ulna resection. The Coders Desk Reference lay description of 25332 doesn't seem to match what was done, and neither does 25337 (but I know there can be variations so the lay descriptions don't always cover all the ways the procedure can be done).
Anyone know what is normally used for the modified Bowers procedure, and is there any official source, website etc. that backs it up? I see plenty of references online to the procedure, but almost never with a CPT code. This is a workers' comp claim and is subject to audit so I hate to pay without being sure if the coding is correct. Any help is appreciated!