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Denovo juvenile cartilage allograft

  1. #1
    Traverse City Michigan
    Default Denovo juvenile cartilage allograft
    Medical Coding Books
    Is anyone using the Denovo juvenile cartilage graft to repair chondral defects in the knee?? We did our first one a few months ago and are having a hard time getting paid. We billed with the unlisted code 27599, using 27412 as a comparison code. BCBS of MI requested the notes to process the NOC code, and are now denying stating the procedure is experimental. I have been told to do an Ombudsman appeal, but need clinical documentation showing the procedure is effective. I have 2 questions really, First has anyone else billed for this and are you using the unlisted or 27412? Second, does anyone have any suggestions of where I can find clinical research on this? I have contacted the company that supplied the graft and have so far not recieved any response. Any help would be MUCH appreciated.
    Chrissy Durga, COSC

  2. #2
    I called the Zimmer Hotline directly...talked to Kathy Miles...very helpful!! 1-866-949-0444 She emailed me information regarding how & why the procedure is done. We use the unlisted procedure for the knee and compare it to CPT 27415....hope this information is helpful.

  3. #3
    Traverse City Michigan
    Thanks for your help, I will give her a call!
    Chrissy Durga, COSC

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