Has anyone had any luck in negotiating reimbursement for Endoscopic Gastrocnemius Release (EGR), reported with code 29999: Unlisted procedure, arthroscopy?
The process is the same for all unlisted codes when negotiating for reimbursement so the specific procedure is not as important as the negotiation process, and a win is a win.
In my 25-year career, I know that reimbursed unlisted codes are rare but possible.
There is a code for the open procedure: 27687: Gastrocnemius recession (eg, Strayer procedure). But that cannot be used for the endoscopic version.
I've been assembling tools to help clinicians establish a fair price and negotiate payment with the carriers and posting them for free on the website: www.ioectr.com. Click on the "Other Procedures Tab" for the unlisted code documents. Any advice or feedback is welcome! I created a sample Spreadsheet to calculate the values based on a comparison code but what I really need is an "official" one from a professional medical association or from someone who has successfully contracted reimbursement.
In addition, this procedure could be performed in the office, or Office-Based Surgical Suite (OBSS), which is a separate issue. I also have information for managers and providers on how to set up an OBSS.
Jeffrey P. Restuccio, CPC
The process is the same for all unlisted codes when negotiating for reimbursement so the specific procedure is not as important as the negotiation process, and a win is a win.
In my 25-year career, I know that reimbursed unlisted codes are rare but possible.
There is a code for the open procedure: 27687: Gastrocnemius recession (eg, Strayer procedure). But that cannot be used for the endoscopic version.
I've been assembling tools to help clinicians establish a fair price and negotiate payment with the carriers and posting them for free on the website: www.ioectr.com. Click on the "Other Procedures Tab" for the unlisted code documents. Any advice or feedback is welcome! I created a sample Spreadsheet to calculate the values based on a comparison code but what I really need is an "official" one from a professional medical association or from someone who has successfully contracted reimbursement.
In addition, this procedure could be performed in the office, or Office-Based Surgical Suite (OBSS), which is a separate issue. I also have information for managers and providers on how to set up an OBSS.
Jeffrey P. Restuccio, CPC