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SLR Graft Jacket

  1. #1
    Location
    Charm City - Baltimore
    Posts
    103
    Default SLR Graft Jacket
    Medical Coding Books
    Hi -

    Surgeon uses a Graft Jacket SLR during a scapholunate interosseous ligament reconstruction. When looking at the vendor's description, it states, it's an acellular dermal matrix that provides complex three-dimensional array of proteins the interact with each other and with the host cells. It includes networks of collagen, elastin and proteoglycans. When asked, the surgeon stated this is non-biodegradable product and acted as a scaffold in the repair.

    My question is, would this be a separately reportable code? The primary procedure is 25320. When I go onto CodeX, this type of graft is not included. It included prep and insertion of DBX, methmethacrylate and hydroxyapatites but I don't see anything about the graft jacket. So would coding for 11981 (insertion of non-biodegradable implant) work? Would a graft that meshes and produces this network of proteins to the ligament count as this?

    Thanks!
    Crystal, CPC, CCS-P

  2. Default
    Quote Originally Posted by CrysLednum View Post
    Hi -

    Surgeon uses a Graft Jacket SLR during a scapholunate interosseous ligament reconstruction. When looking at the vendor's description, it states, it's an acellular dermal matrix that provides complex three-dimensional array of proteins the interact with each other and with the host cells. It includes networks of collagen, elastin and proteoglycans. When asked, the surgeon stated this is non-biodegradable product and acted as a scaffold in the repair.

    My question is, would this be a separately reportable code? The primary procedure is 25320. When I go onto CodeX, this type of graft is not included. It included prep and insertion of DBX, methmethacrylate and hydroxyapatites but I don't see anything about the graft jacket. So would coding for 11981 (insertion of non-biodegradable implant) work? Would a graft that meshes and produces this network of proteins to the ligament count as this?

    Thanks!
    Our docs use these Graft Jackets once in awhile when doing RCR's. We add -22 to the CPT on the Professional claim to represent the additional work and then bill out Q4107 on the Facility (ASC) claim for reimbursement of the actual supply.
    Jenna

  3. #3
    Location
    Charm City - Baltimore
    Posts
    103
    Default
    Thanks! Didn't even think about the 22! Have you been successful in capturing increased revenue?

    Crystal, CPC, CCS-P

  4. Default
    Quote Originally Posted by CrysLednum View Post
    Thanks! Didn't even think about the 22! Have you been successful in capturing increased revenue?

    Yes, I type up a letter to send with the claim explaining exactly why the case is "above & beyond" the usual. Of course sometimes there are those claims that we can't get them to pay additional no matter what!

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