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Wiki Sacroplasty Billing

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JRalston

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13
Location
Wichita Falls, TX
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My physician performed a sacroplasty and is questioning my use of CPT
0201T. He continues to insist that I should bill 22899. Obviously Medicare doesn't pay the 0201T. Is there anything else that I can use? I'm not finding anything else but just wanted to double check.

Thanks!!!
Jen
 
According to CPT, if a category code III is available, this code must be reported instead of a category I unlisted code. I recently had a sacroplasty deny by Medicare as service not reasonable or necessary. Unfortunately we did not have an ABN signed by the patient. You are correct in not using the unlisted code.
 
Sacroplasty

That all depends on if a balloon or mechanical device was used. If it was not used then it would still be 22899. I have come across this situation before.
 
Hi slc,
I appreciate your input. I hadn't thought about the unlisted spine code. My surgeon did not use a balloon of mechanical device.
Thanks
 
Check the Vertebroplasty policy with your Medicare carrier. They may make mention of sacroplasty and if it is payable or not. If payable under certain circumstances, they will list the CPT and ICD-9 in the LCD instructions. You are always able to follow their written instructions for coding as long as the case meets the criteria in the written part of the policy under limitations of coverage.
 
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