Wiki Talon System

[Kelly_Mayumi]

Is anyone familiar with the Talon System? My surgeon preformed a 33464 and 33530. He applied the talon system before closing the skin.

 

[lisigirl]

Yes, my surgeons have used it. I bill it with code 21825.

This sternal fixation device should only be used when patients have one of the co-morbidities listed below and it is important for this to be documented in the op note.

- morbid obesity
-severe osteoporosis
-COPD
-previous sternotomy
-infection
-chronic steroid dependancy

If you're using 33530, I assume the patient has already had a sternotomy so you should be ok.

Lisi, CPC
eharkler@nmh.org

 

[gost]

The manufacturer says:

"The system can be used for all cardiothoracic patients but is especially suitable for those at high risk resulting from:
• Morbid obesity
• Diabetes
• Chronic obstructive pulmonary disease
• Transverse sternal fractures

Contraindications
1) Active infection.
2) Patient conditions including: blood supply limitations, insufficient quantity or quality of bone, severe osteoporosis or latent infections.
3) Patients with mental or neurological conditions who are unwilling or incapable of following postoperative care instructions.
4) Foreign body sensitivity. Where material sensitivity is suspected, tests are to be made prior to implantation."

I believe the proper CPT code would be 21750.

 

[Kelly_Mayumi]

Yup, I do have those comorbidities, so I am good there. Both are good code choices, although I worry about 21750 being a seperate procedure. If I open the sternum, I'm going to close it.

 

[lisigirl]

KLS Martin has advised to use code 21825 for the fixation device (the Talon system). As you said, closing the sternum is included in the primary surgery (so forget 21750) but if the sternum is so unstable that it requires an additional fixation device, then you can bill for placement of this device.

And yes, while the Talon system can be used on any cardiothoracic patient, it is most suitable for patients with those co-morbidities (because they support the need for an additional fixation device).

Lisi, CPC

 

[CRC CPC]

Thank you for clarifying that because when I called the Manufacturer they gave me the code 21750. But after reading up on it I like the 21825 much better. I learn something new everytime I visit the forum Did you watch the video demonstation they had on the website? I was very impressed....

 

[rsadkins]

I know the manufacturer lists comorbidities for indication of use of the Talon. I question if medicare should be billed, because of the NCCI edits, in Chpt 5 page V10 it states:

11. If a median sternotomy is utilized to perform a cardiothoracic procedure, the repair of the sternotomy is not separately reportable. CPT codes 21820-21825 (treatment of sternum fracture) should not be reported for repair of the sternotomy.

The Talon rep says that STS says it is okay to bill with modifier 59, and is to get me the link to that statement.

 

[gost]

21825 is for repair of a fracture, not for surgical incision. If you're billing for the sternal closure, I assume it is a delayed closure. In that case 21750 and modifier 58 seem appropriate to me. If the closure is during the same operative session as the primary procedure, it probably is not payable. Closure is part of the surgery regardless of the method.

 

[lisigirl]

The STS does have this on their website, its under the STS Coding Today section which you need a password for. They've advised coders to use 21825.

The RVUs encompassed in typical cardiothoracic surgical operations do not include the work associated with CPT 21825 and therefore is not in conflict with CCI. Yes, the sternum needs to be closed if opened but when the sternum is incompetent, additional work may be necessary to close it (like the Talon system) and this is not standard on all procedures.

As far as the sternal fracture goes, you can argue that although the surgeon cut open the sternum, it is still a break in the continuity of the bone thereby being a fracture.

Lisi, CPC