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Bone supplement HCPCS code needed

  1. #1
    Default Bone supplement HCPCS code needed
    Medical Coding Books
    For the screws, for Cigna, we use C1713, and that got pd, but for the bone supplement and guidewires (see below), they denied - we did send in invoices/implant records/opreport, using L8699 for all these years, this is the first time this is denied:

    ~The ETX BSM/gamma calcium phosphate supplement was then prepared. Using approximately 4 cc of the 5 cc prepared, it was placed in the elevated portion of the lateral tibial plateau. After reaming over the guidewires, two 4.5 mm screws were then placed. ~

    Does anybody have another code we can use? These Insurance companies keep on changing the rules on a daily basis, it's hard to keep up! LOL!

  2. #2
    What CPT code do you use for reaming?

  3. #3
    The procedure was a 29855, which includes the reaming. I don't know that there is a seperate code for reaming.

  4. #4
    For in case anybody else needs this, here is the response from the Etex rep:

    October 5, 2009
    Coding is at the discretion of the provider. Coding information is provided here
    solely as a reference.
    A facility, whether inpatient/outpatient or hospital/surgery center, may choose to
    code ETEX materials as the currently do for other bone graft materials.
    There is not a specific CPT of HCPCS code for the implantation of ETEX
    products, but each facility may have a pass through, revenue or carve out code depending on the insurance.
    One code that may be relevant in an outpatient setting is a HCPCS Code, C1713. Anchor for opposing bone-to-bone or soft tissue-to-bone. This category now also applies to synthetic bone substitutes that may be used to fill bony voids or gaps (ie, bone substitute implanted into a bony defect created from trauma or surgery).
    For the inpatient setting, one code that may be relevant is:
    ICD-9 84.55, Insertion of bone void filler
    Insertion of:
    acrylic cement (PMMA)
    bone void cement
    calcium based bone void filler
    polymethylmethacrylate (PMMA)
    that with kyphoplasty (81.66)
    that with vertebroplasty (81.65)

  5. #5
    Charleston, South Carolina
    I have tried to open the link supplied above and cannot access it as I do not have a login for that site. Can you please provide what resource the link references as to what is included now in this code? I have looked at all of my resources and see nothing that includes bone substitutes, such as Etex.

    Thanks for your help!
    Machelle Morningstar, CPC, COC, CEMC, COSC
    AHIMA Approved ICD-10-CM/PCS Trainer

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