Subchondroplasty-Injection of Accufill bone filler

terribo

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We have supporting documentation from the CPT Assistant to use CPT code 29855 for the DX of a fracture of the tibial plateau when a "subchondroplasty" (Injection of Accufill bone filler) is performed. However, if the procedure is performed on the femoral condyle for any DX, the code has to go unlisted as 27509. From what I understand, the recommendation is to compare it to 29855. Is anyone getting paid for this procedure based off of the unlisted code 27509 for the subchondroplasty to be performed on the femoral condyle? If you received payment, what information did you put in block 19 of the claim form to describe the procedure to the provider if submitted unlisted 27509?

Thank you for your help.
 

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KG123

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27509 isn't an unlisted code. It's"Percutaneous skeletal fixation of femoral fracture, distal end, medial or lateral condyle, or supracondylar or transcondylar, with or without intercondylar extension, or distal femoral epiphyseal separation". The unlisted code is 27599, is that what you meant?
 

terribo

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27509 isn't an unlisted code. It's"Percutaneous skeletal fixation of femoral fracture, distal end, medial or lateral condyle, or supracondylar or transcondylar, with or without intercondylar extension, or distal femoral epiphyseal separation". The unlisted code is 27599, is that what you meant?
Yes, I apologize. I meant bill with CPT 27599 and compare to 27509. Since this post, we are now performing the injection of bone filler which Zimmer calls Subchondroplasty into the talus and calcaneus. Will this be billed unlisted 27899 and compare to 28445?
 

Schadburn

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We recently switched to doing 29855 (tibia) and 27599 (femur). We were doing 29999 before. My provider has recently decided to essentially do the femur for free and has asked me to stop billing the unlisted code. I haven't heard any updates about how these are getting paid yet but I have been meaning to reach out about it. I will update you once I hear anything.
 

terribo

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Zimmer posted on their website the following for the injection of the bone filler into the tibia the following:
"When a patient presents with a stress fracture with a bone marrow lesion of the medial tibial plateau, performance of a
percutaneous arthroscopically assisted internal fixation of a stress injury using an arthroscope for visualization AND to inject
calcium phosphate into the medial tibial plateau should be reported with code 29855. CPT Assistant September 2018".
Our ASC agreed with billing 29855 for the injection of bone filler however, after reading medical policies from several North Carolina Insurance Companies, I have been convinced that the 29855 may only be billed for the injection of bone filler IF Internal Fixation/Intramadullary fixation was performed as well. In the case of the injection of bone filler for our patients, only the injection of bone filler is being performed. This would be unlisted and most insurance companies deem the injection of calcium phosphate (Accufill) a investigational procedure and no reimbursement has been provided. We have been getting paid for the 29855, but I'm afraid that it may be incorrect due to no internal fixation is being performed in conjunction with it in our cases. Thank you for responding and the info. I will update as well if I hear anything else.
 

clark.amy86

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We recently switched to doing 29855 (tibia) and 27599 (femur). We were doing 29999 before. My provider has recently decided to essentially do the femur for free and has asked me to stop billing the unlisted code. I haven't heard any updates about how these are getting paid yet but I have been meaning to reach out about it. I will update you once I hear anything.
Do you have an update on how those claims processed? I am looking for a way to crack the code with these procedures, so any information is helpful!
 

terribo

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clark.amy86
Since my original post regarding the Subchondroplasty procedure, we have been directed to bill the Subchondroplasty procedure as the unlisted CPT code per the anatomic site according to how the procedure was documented as being performed open vs arthroscopically.
Per CPT Assistant November 2019/Volume 29 Issue 11, CPT code 29855 is not appropriate for injection of calcium phosphate (Subchondroplasty procedure) into a bone-marrow lesion that does not require a reduction.

As an FYI, we have found that most insurance companies have a policy in place that states the Subchondroplasty/Injection of Bone Filler is considered experimental and will not be reimbursed. Our new policy for this procedure is to set the fee for the procedure, have the patient sign a waiver stating they are responsible should the procedure be denied as experimental, bill the unlisted code to the insurance company, and bill patient if denied.
 

clark.amy86

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clark.amy86
Since my original post regarding the Subchondroplasty procedure, we have been directed to bill the Subchondroplasty procedure as the unlisted CPT code per the anatomic site according to how the procedure was documented as being performed open vs arthroscopically.
Per CPT Assistant November 2019/Volume 29 Issue 11, CPT code 29855 is not appropriate for injection of calcium phosphate (Subchondroplasty procedure) into a bone-marrow lesion that does not require a reduction.

As an FYI, we have found that most insurance companies have a policy in place that states the Subchondroplasty/Injection of Bone Filler is considered experimental and will not be reimbursed. Our new policy for this procedure is to set the fee for the procedure, have the patient sign a waiver stating they are responsible should the procedure be denied as experimental, bill the unlisted code to the insurance company, and bill patient if denied.
Thank you for replying! I was hoping that wouldn't be the case, but we may have to go that route as well.

Also, I have only seen one of these procedures get paid by insurance (Anthem BCBS of CA) in the past year and that wasn't until a month ago. It took three months to get it paid, but it was paid as unlisted with the comparison to 29855 along with records and an explanation letter for the usage of the unlisted code. Its my unicorn 🦄and I would not be surprised if they change their minds and recover their money...but it does give me a small percentage of hope:)
 

01042035

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Wow, Amy congrats. BC Anthem never pays anything experimental. Here's hoping they don't rethink that and come back for their money. Thanks for all the good info everyone. This will be helpful to share with my doctor.
 
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