Wiki question

[coderbeth]

I need a little help here, I have gotten advice that I don't think is correct.

Attention was directed to the left heel, where a stab incision was performed over the medial heel with an 11 blade and blunt dissection was performed with a hemostat down to the plantar fascia. Under ultrasound guidance, the Tenex Bbone was set on low settings and used to perform debridement of the plantar fascia, thus performing a percutaneous plantar fasciectomy through the Tenex ultrasonic debrider without incident. Next, the settings were changed to high and the Tenex Bone was used to remove the infracalcaneal exostosis on the plantar heel without incident and fluoroscopy was used to show resectional dissection. The operative site was irrigated with normal saline and wound was closed with 3-0 nylon.



Attention was turned to the posterior heel where stab incisions were performed medially and laterally and the Tenex Bone procedure was used to perform ultrasonic debridement of the Achilles tendon and resection of the calcific tendinitis of the posterior heel under fluoroscopic guidance. After adequate resection, one final view was saved for the record. The operative site was copiously irrigated with normal saline and skin closed with _____ of 3-0 nylon. The foot was cleaned with normal saline-soaked gauze, dried and a dressing of Xeroform, 4 x 4, gauze wrap and Ace wrap was placed about the extremity.



The patient tolerated the procedure well and transferred to recovery with vital signs stable and vascular status intact to the left lower extremity. She can be discharged home. Is instructed to be nonweightbearing, wear postoperative shoe on the left, elevate the extremity above the heart and follow up with me next week. She was given prescriptions for Norco and Naproxen, which were sent to her pharmacy on file.

The advice given is : 27654,28118 and 28060
I don't see where they repaired the achilles..
I was thinking 28119 with unlisted 27899 but I feel like that bundles as well

 

[podcoder70]

Unfortunately, the Tenex technology is still considered investigational. There are codes that are "kind of like" what was done, but not really, "kinda similar" cannot be coded. In your example, you cannot bill 28060 because of the technique used. 27654 also cannot be used because there was no repair done, only debridement. 28118 and 28119 indicate an ostectomy and the op report states "resection of calcific tendinitis" not bone. In addition, since the Tenex was used, none of these codes can be used.

I advise the 27899 and submit with the op report, a supporting article on the use of the Tenex and a letter of medical necessity. This makes your billing clean with no misrepresentation. You did not say who the payer is...in any case, if the doctor chooses to use this technique again, patient should sign acknowledgement that it is investigational, AND, prior auth should be obtained for commercial payers.

 

[coderbeth]

Thank you so much!

 

[jalbarran]

Unfortunately, the Tenex technology is still considered investigational. There are codes that are "kind of like" what was done, but not really, "kinda similar" cannot be coded. In your example, you cannot bill 28060 because of the technique used. 27654 also cannot be used because there was no repair done, only debridement. 28118 and 28119 indicate an ostectomy and the op report states "resection of calcific tendinitis" not bone. In addition, since the Tenex was used, none of these codes can be used.

I advise the 27899 and submit with the op report, a supporting article on the use of the Tenex and a letter of medical necessity. This makes your billing clean with no misrepresentation. You did not say who the payer is...in any case, if the doctor chooses to use this technique again, patient should sign acknowledgement that it is investigational, AND, prior auth should be obtained for commercial payers.

Per

CPT® Assistant.​

Download PDF
Surgery/Musculoskeletal System
September 2009; Volume 19: Issue 9: As well as Tenex Health--this would be reported with the appropriate fasciotomy codes as the Tenex as well as Topaz are tools used to achieve the goal-they are themselves not procedures: Payors are often requesting the procedure notes for fasciotomy/fasciectomy procedures and may deny based on the tools ie; Tenex/Topaz used per individual payor policies.

Surgery: Musculoskeletal Sysem, TOPAZ device (Q&A)

Question: What is the appropriate code to report when the TOPAZ device is used to perform a procedure?

Answer: The TOPAZ MicroDebrider is a tool which utilizes Coblation® technology to perform a small incision in the fascia and is considered an alternative to the use of standard surgical instruments such as scalpels, low frequency electrocautery, and so forth. This technology enables the microdebridement of soft tissue present within the tendons of the knee, shoulder, elbow, ankle and foot. Because the TOPAZ MicroDebrider is a tool and not a procedure, code selection will depend on the service performed, and the specific anatomy involved, as it can be used on different parts of the body. The appropriate code should be selected based on the definitive procedure being performed as described in the code descriptor.

 

[podcoder70]

Per

CPT® Assistant.​

Download PDF
Surgery/Musculoskeletal System
September 2009; Volume 19: Issue 9: As well as Tenex Health--this would be reported with the appropriate fasciotomy codes as the Tenex as well as Topaz are tools used to achieve the goal-they are themselves not procedures: Payors are often requesting the procedure notes for fasciotomy/fasciectomy procedures and may deny based on the tools ie; Tenex/Topaz used per individual payor policies.

Surgery: Musculoskeletal Sysem, TOPAZ device (Q&A)

Question: What is the appropriate code to report when the TOPAZ device is used to perform a procedure?

Answer: The TOPAZ MicroDebrider is a tool which utilizes Coblation® technology to perform a small incision in the fascia and is considered an alternative to the use of standard surgical instruments such as scalpels, low frequency electrocautery, and so forth. This technology enables the microdebridement of soft tissue present within the tendons of the knee, shoulder, elbow, ankle and foot. Because the TOPAZ MicroDebrider is a tool and not a procedure, code selection will depend on the service performed, and the specific anatomy involved, as it can be used on different parts of the body. The appropriate code should be selected based on the definitive procedure being performed as described in the code descriptor.

I don't disagree with CPT Assistant, however, my experience is that the payers consider the tool experimental and therefore not covered. I defer to my original answer regarding the procedure performed using the device, coding is based on the procedure, the tenex and topaz tool may not perform the procedure according to the description of the code, I advise to code what you feel is appropriate, I can only share my experience.