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Wiki Scaphoid proximal pole nonunion - cpt

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RebeccaMoney

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I need help with the CPT. I'm looking at 25440 but wasn't sure if this is for the proximal pole. Doctor also does 25430, vascularized graft, that he took from the distal radius. Is 25430 billable since taken from different site?
Thank you,
 
Hello!!
We use the 25440 for ANY Scaphoid nonunion repair (Proximal, Middle/Waist, or Distal scaphoid).
The 25430, vascular pedicle insertion, is another beast all together. The codes bundle per CCI, with 25430 being included in 25440. If your Carrier contracts state they follow CCI, it is going to deny included. 25440 by definition includes the graft harvest, so we do not chase this coding pair.
I have billed the 25440 with the -22 modifier and submitted a letter from my Provider explain how a vascular pedicle is harder, technically more difficult, etc to attempt a higher reimbursement.

Respectfully,
 
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