Wiki Shoulder-Rotator cuff procedures with allograft, any official guidance?

[kfoote16go]

Is there any official coding guidance on including a code for the application of allograft/xenograft in a rotator cuff reapir/reconstruction procedure or in shoulder arthroplasty . Lots of conflicting information on the web, posts on the forum, allograft manufacturer reimbursement guides. The AHA Coding Clinic from Q1 2006, looks to be more specific to the assignment of ICD-9 "Assign code 83.63, Rotator cuff repair, for the procedure performed. The allograft graft jacket was used to reinforce the repair and is captured with the code assignment for the repair."

Some contradictory information I have found:
- application of graft is included in the procedure so only code the RC procedure (23410, 23412, 23420, 29827) or arthroplasty (23470, 23472) alone.
- to add modifier -22 to the primary code
- to add code +15777 (although "ie, Breast,Trunk" is part of the code and per CPT Assistant Oct 2013, its use is only in the breast or trunk)
- to add code 17999

Can anyone offer help, I was excited to see an AAPC Shoulder coding article in the July Healthcare Business Monthly, but no mention of graft!

Thank you in advance!

 

[sxcoder1]

Is there any official coding guidance on including a code for the application of allograft/xenograft in a rotator cuff reapir/reconstruction procedure or in shoulder arthroplasty . Lots of conflicting information on the web, posts on the forum, allograft manufacturer reimbursement guides. The AHA Coding Clinic from Q1 2006, looks to be more specific to the assignment of ICD-9 "Assign code 83.63, Rotator cuff repair, for the procedure performed. The allograft graft jacket was used to reinforce the repair and is captured with the code assignment for the repair."

Some contradictory information I have found:
- application of graft is included in the procedure so only code the RC procedure (23410, 23412, 23420, 29827) or arthroplasty (23470, 23472) alone.
- to add modifier -22 to the primary code
- to add code +15777 (although "ie, Breast,Trunk" is part of the code and per CPT Assistant Oct 2013, its use is only in the breast or trunk)
- to add code 17999

Can anyone offer help, I was excited to see an AAPC Shoulder coding article in the July Healthcare Business Monthly, but no mention of graft!

Thank you in advance!

I have the same problem. I have done 23412 with 17999 (used to use 15777 although decided that was incorrect), but insurance doesn't pay the 17999. So now I'm just thinking 23420 since it includes grafting. Not sure!

 

[jason.lang]

After deep research into this, I've discovered that IF arthroscopic the best case scenario and advise is to bill 29999 (Regeneten Path procedure, compare to 23412). 23412 is for OPEN procedure but the lay term describes the procedure to a "T". 17999 wouldn't be appropriate because it's not from the Orthopedic code set.