Use of CPT 15777

LaurenBrooke

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CPT 15777: Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure)

Within the notes for this code it states when using a biological implant for soft tissue reinforcement in areas other than the breast/trunk to report 17999. I see this soft tissue reinforcement often when reviewing superior capsular reconstruction.

Here is where I need clarity or guidance:

My physician states because the code description states (ie, breast, trunk) this is not limiting the use to only breast or trunk but giving an example. In the past (years ago) I too believed this, and I actually was the one to suggest it's use initially. However, it is clearly stated within the notes and instructions to use unlisted procedure code 17999 when using a biological implant in areas other than breast or trunk. I have since been using the unlisted code outlining what it is representing, what CPT it is compared to, and how it was utilized within the procedure. Like with any unlisted code, it is more difficult to have this paid. Currently faced with a denial wanting a LMN (which I typically write) but my surgeon is wanting to void the unlisted and code 15777 (is quite adamant). I do not feel comfortable with this choice seeing how the code book guides its users to use the unlisted code in this scenario.

Are there any suggestions on this, or better yet- a clear guideline regarding the scope of CPT 15777 and whether or not it is truly limited to breast/trunk?
 

thomas7331

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The abbreviation 'i.e.' used in CPT means 'in other words' or 'that is to say', and should not be interpreted to mean 'for example' (which is abbreviated 'e.g.'), so in light of this I think the CPT intends this only to be used for procedures involving the breast and trunk. In addition, CPT Assistant, January 2019, in Frequently Asked Questions has issued supporting guidance on this in stating that "15777 is reported for soft-tissue reinforcement involving only the integumentary system, which should be used only for non-surface soft tissue applications of biologic implants, such as in the breast and trunk. If reinforcement is placed in tissues other than the breast or trunk, code 17999, Unlisted procedure, skin, mucous membrane and subcutaneous tissue, should be reported."
 

LaurenBrooke

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The abbreviation 'i.e.' used in CPT means 'in other words' or 'that is to say', and should not be interpreted to mean 'for example' (which is abbreviated 'e.g.'), so in light of this I think the CPT intends this only to be used for procedures involving the breast and trunk. In addition, CPT Assistant, January 2019, in Frequently Asked Questions has issued supporting guidance on this in stating that "15777 is reported for soft-tissue reinforcement involving only the integumentary system, which should be used only for non-surface soft tissue applications of biologic implants, such as in the breast and trunk. If reinforcement is placed in tissues other than the breast or trunk, code 17999, Unlisted procedure, skin, mucous membrane and subcutaneous tissue, should be reported."

Thanks so much for this. I have sent this along as well. I appreciate you confirming the i.e./e.g.
 
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