Wiki Wrist fusion with scaphoidectomy

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TammyVan

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My doctor does limited & total wrist fusions, along with the scaphoidectomy. He uses the excised scaphoid for the autograft. I feel the scaphoidectomy would be bundled...especially since it's used for the autograft. I have billed out CPT 25825 for the limited fusion with autograft when he has done the fusion with the scaphoidectomy as the autograft. He has argued that we should also bill out CPT 25210.
An example of the dictation regarding the scaphoidectomy:

Significant degenerative arthritis was noted on the proximal pole of the scaphoid with
grooves dug into the exposed subchondral bone. The scaphoid was significantly attenuated. The soft tissue attachments were carefully elevated off the scaphoid and the scaphoid was resected. The scaphoid bone was then cleaned of any cartilage and soft tissue attachments and used for autologous bone graft.

Please advise if the scaphoidectomy is a separate procedure in this case. Please provide references for proof of proper coding.

Thanks for any and all information & guidance :eek:
 
I am the surgical coder for a group of hand surgeons - when coding 25825 the CPT clearly states with autograft (includes obtaining graft). I ran these two codes through Optum360 EncoderPro and 3M Coding and Reimbursement System and both have CCI conflicts. Optum states "Code 25825 (column 1) has a CCI conflict with code 25210 (column 2). A modifier is allowed to override this relationship. 3M states "You have coded 25825 with an additional code(s) considered a component of this procedure. The Medicare NCCI edits consider this separate reporting of codes that are components of the comprehensive procedure if billed for services provided to the same beneficiary by the same physician on the same day. These codes will be rebundled by your Medicare payor and payment will be based on 25825 only. * If these codes represent a different session, surgery, site, lesion or injury, then use of an appropriate modifier on the excluded code will differentiate the services provided and will notify the payor to bypass this edit. I also just received 2017 AAOS Global Service Data and for CPT 25825 under Services INCLUDED in the global service package: #14. excision of cartilage and bone from radiocarpal and/or intercarpal joints. Hope this helps!
 
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