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Graft Jackets

  1. #1
    Default Graft Jackets
    Medical Coding Books
    My doc is using a "graft jacket" as a spacer at MPJ when doing a bunionectomy.

    I do not believe you can charge for this because it is a skin graft and therefore using in a joint space is not what the graft was made for/FDA approved/medically neccessary use of the graft jacket.

    I went to a Margie Scalley Vaught seminar on shoulders where this question was asked in reference to using the graft jacket as a tenon graft in a supraspinatus repair and the answer was you cannot use a skin graft as a tendon graft.

    Anyone have any insight on this. Do you charge for this?

  2. Default Use of Graft Jacket
    We use the graft jacket at the facility I work at. It is a gortex type graft and I see it with the rotator cuff repairs (they call it Conxea, which is the brand name). This doctor wants to code it with the 24320, reconstruction of the shoulder. I keep telling them it is just a rotator cuff repair with the modifier 22. But of course, they do not want to use the
    22 modifier due to extended wait on payments. It has gotten so that this physician almost always uses the Conexa graft now. I also see it with the repair of the nerve, which is to say the doctors "wrap" the nerve to help reduce scar tissue build up. I try to explain to the doctors the graft jacket cannot be charged (64910 - I think this is the code they use) for unless the doctor us physically suturing the nerve end to the graft. Just wrapping does not constitute a "repair" of the nerve. In your case, they too are using the graft for something different than an actual repair and this is not a billable "graft" since it is not a tendon, fascia etc. This is my thought on this topic

  3. #3
    Default Open Rotator Cuff Repair with Graft Jacket
    Has anyone used add-on CPT 15777 for the shoulder graft jacket supplement? Our provider is doing an open rotator cuff repair with this graft procedure. We had a payer tell us they would pay CPT 23412 + 15777.
    Donna L Christian, CIRCC, CEMC, COSC, CCS-P

  4. #4
    Take a look at 1st Quarter 2006 AHA Coding Clinic titled Rotator Cuff Repair and Allograft Jacket. The graft appears to be inclusive of the repair code.

  5. #5
    In regards to graft jackets, CPT guidelines instruct you to use 17999 in tissues other than breast and trunk.

    Gina D. Belafonte CPC, CPC-H, CPMA, COSC, CGSC

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