Wiki Syme’s amputation/distal transtibial amputation

[werner03]

Do any of you have any that do this procedure as well as due transpositional muscle flaps and nerve transfers\relocations? These are taking about 4-5 hours to do.
Since there is so much involved in this procedure should we bill as an unlisted procedure to see if we can get 1 fee or should we try to separate each procedure? There is only a few surgeons that are doing this procedure and the list of codes are all over the place.

Any supercoders out there on suggestions?

 

[amyjph]

I am not specifically familiar with the procedure however, you can't use unlisted codes if there are CPT that describe the procedure(s) being performed. Providers can't use an unlisted because they don't like the reimbursement associated with a known CPT or to try to get paid more/differently. Depending on the exact procedures being done you would have to use the correct CPT code for each one. If the case is very complicated and the documentation supports it, this is where you would use a 22 modifier for increased procedural services and increase the fee. You would have to track the reimbursement to make sure the provider actually got paid more. Most times it requires op report submission as well. Just quickly looking at a couple searches about the procedure, I feel the code is 27888, it specifically names Syme in the description and includes plastic closure and resection of nerves. If there are additional flaps and nerve transfers not included in the main CPT, that would be additional codes (possibly depending on bundling).

If there really are no CPT codes that describe what is involved in a case, only then would you go to an unlisted. In my experience, I have worked with some providers on new procedures for which there was no code and worked together to decide a comparison code and appropriate fee for the unslited. It takes more work and usually much longer to get paid/paid the correct amount in my opinion.