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Pre-Cert for Unlisted Surgery

  1. #1
    Long Island/New York
    Default Pre-Cert for Unlisted Surgery
    Medical Coding Books
    I've never done one of these before - so I need a little help. One of our Dr's needs a pre-cert for an unlisted surgical procedure on the Hip. We need to show that this unlisted procedure is more difficult than CPT codes 27140 (Osteotomy and transfer of greater trochanter of femur), 27033 (Hip, removal of foreign body) and 27161 (Osteotomy, femoral neck). The dx code is 732.1 (Perthes disease).

    The surgery is an open "femoral neck relative lengthening with a troch distalization", osteochondroplasty and labral repair. I would use an unlisted code for labral repair and osteochondroplasty BUT it seems my Dr wants to show that the "relative femoral neck lengthening" is more difficult than BOTH 27033 AND 27161.

    I've never seen this femoral neck lengthening done before and it seems obviously more difficult than 27161 (as the 27033 should be allowed as the patient has an infection). My question is what would you specify (they need 2-3 things listed that show it being more difficult) to get this surgery approved?

    I have little to no direct contact with my Dr since we're a billing company miles away and he is always busy!!

    Has anyone ever done a surgical procedure like a femoral head lengthening that can give me a little insight? Thanks for any help.

  2. Default

    I am coding a similiar case, having difficulty with it and wondering what codes you ended up coding your case with. Any insight would be helpful.


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