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Question Patellofemoral Arthroplasty code

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JPerry2000

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Morgantown, WV
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It is my understanding that a Patellofemoral Arthroplasty should code to 27599 unlisted, since 27438 is for the patella component only. I have a Commercial insurance plan that says coding unlisted for this procedure is incorrect and that code 27438 is the correct code. Can I have some input on how others are coding this procedure?
 
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If the commercial plan wants you to bill 27438 and they will pay you for it, as opposed to an unlisted code that has no associated RVU value and will be denied, why are you shooting yourself in the foot and arguing with them? Yes, they're wrong, but you're unlikely to succeed on the merits. You could append a -22 modifier to get increased reimbursement for the femoral work, but you'd need good documentation. That might be a better strategy.
 
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This is in an ASC so we aren't supposed to use modifier 22. I agree with your comment but what if the payer performs a post payment review and then requests the payment back?
Would you entertain billing the PFJ to other payers with that CPT code instead of the unlisted?
Thank you very much for your input.
 
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