Wiki Subchondroplasty of Patella and tibia -no fracture involved

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angrhode

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Wondering if anyone has any info on billing out the subchondroplasty? I have the Zimmer knee creations procedure coding reference guide. I know it would be an unlisted code for the femur or knee but unsure on which code to compare it to. Any suggestions would be great.
 
Subchondroplasty

Looking for advice out there---my Office Manager is looking at billing Subchondroplasty and has a couple questions:


1) What documentation do they need to support this and get paid?

3) Are any payers paying for this yet? I see posts to use the unlisted code

2) Is there any ?words? or ?verbiage? they shouldn?t use? At one point, she had mentioned to not use something because she thought if it was reviewed it would be deemed experimental and money would be recouped.

Any advice or references would be very benificial!

Thank you in advance~
Marty
 
27599 is what I use for subchondroplasties, depending on the approach. I just checked some reports and I show that the payers are paying for them. Note that it MUST be for a fracture. Your dx should be a fracture dx.
 
It depends on the approach. My physicians use the Accufill system. It's done percutaneously and then checked later with an arthroscope to ensure the fracture is filled and no excess material broke off into the joint.

29855 and 29856 do not apply for subchondroplasty. According to the Coders Desk Reference for Procedures, those codes are to treat a fracture. Trying to use those codes for the subchondroplasty is bending the CPT book rules, as well as what the procedure really is. If the physician is going to do a subchondrplasty it should be precerted/pre-auth'd and billed with 27599.
 
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