Q: Are screws, SutureTaks, Bio-Composite Screws, SwiveLocks, PushLocks, Pec button or Dog Bone Buttons considered implants or anchors? What HCPCS code options are available to bill the private commercial insurer? HCPCS C1713
A: Anchor for opposing bone-to-bone or soft tissue-to-bone (C1713) - Implantable pins and/or screws that are used to oppose soft tissue-to-bone, tendon-to-bone, or bone-to-bone.Screws and buttons oppose tissues via drilling as follows: soft tissue-to-bone, tendon-to-bone, or bone-to-bone fixation. Pins are inserted or drilled into bone, principally with the intent to facilitate stabilization or oppose bone-to-bone. Includes - orthopaedic plates with accompanying washers and nuts and synthetic bone substitutes that may be used to fill bony void or gaps (i.e., bone substitute implanted into a bony defect created from trauma or surgery).
Q: Are the following products; SutureLasso, FiberWire/TigerWire billable? If so what HCPCS is required?
A: These are considered sutures and there is not a unique HCPCS code. Code these products as supplies.
Q: What HCPCS code is appropriate when billing for instruments, Scorpion Needle or positioners?
A: These are considered a supply or instrument and there is not a specific HCPCS code.
Q: Can you provide any guidance on HCPCS code Q4125 assignment? Is this code appropriate for skin sub graft applications and soft tissue procedures?
A: HCPCS Q4125 code reports the ArthroFLEX product. ArthroFLEX was removed from the Medicare skin substitute graft product list of high/low cost products as of January 1, 2016. The HCPCS code Q4125 still exists for reporting other uses of the product such as in soft tissue procedures. Some private commercial payors may still recognize this Q code for skin substitute graft procedures. Facilities may need to report a HCPCS code for products (biologics), such as Q4125, per private commercial carrier guidelines. CPT coding commonly includes the physician work of utilizing biologics. An unlisted code, CPT 17999, may be appropriate for reporting soft tissue use of ArthroFLEX.
Q: When our physician does a Complete Plantar Plate Repair (CPR) what CPT code do you suggest billing?
A: Use a CPT Code and code what was performed. Some examples are 28285, 28308, 28270 or 28899 (unlisted) Modifiers, such as -22 (increased procedural services), may be useful when there is a significant increase in the time, complexity and/or resources required for a procedure, as documented in the medical record.
Q: Recently the orthopaedic surgeon used an instrument kit that spins blood down to separate out the plasma. He injects the plasma into his patient’s orthopaedic site during surgery. As per the medical notes, the surgeon is listing this procedure as an ACP PRP. How do I code for this procedure?
A: Category III CPT Code 0232T. This code is a highly bundled code and is the only code that can be used. Because of the Cat III status there is often no reimbursement and RVUs are not established for this code.
Q: Is there a description of Arthrex ACP® System? What code would you recommend?
A: ACP - How it works:
- ACP (Autologous Conditioned Plasma)
- Platelets (PLTs) contain Growth Factors (GFs). GFs help to promote and modulate healing.
- The ACP Double Syringe facilitates the safe and rapid preparation of platelet-rich plasma (PRP) from a small sample of the patient’s blood. Following centrifugation, the concentrated platelets are withdrawn from the ACP Double Syringe and applied at the point-of-care.
- ACP can be mixed with autograft and allograft bone prior to application at an orthopaedic surgical site as deemed necessary by the clinical use requirements.
Q: How can we understand the coding pathway options for BioCartilage and Cartiform procedures performed in various anatomies? Who determines the appropriate coding pathway?
A: CPT coding pathways are always determined by the physician and are based on the actual procedure performed and the documented medical record. The choice of code must be made by the physician and may differ depending on the details of the individual case.
Q: Is there a HCPCS code for dressing single layer JumpStart?
A: The JumpStart is considered a wound dressing and is coded as a supply.
Q: Could you please tell me if there is a HCPCS code associated with your SpeedBridge implant system?
A: The anchors are reportable and the FiberWire is considered a suture. Use the HCPCS C1713 for the implant.
Q: Is there a recommended HCPCS code for StimuBlast?
A: This is considered a Bone Void Filler and connects bone to bone (see CMS long description). The HCPCS code is C1713.
Q: What is the HCPCS code for item AR-2257 TightRope Repair Kit?
A: The kits contains two anchors that are reportable and sutures (like FiberWire or TigerWire). The code is HCPCS C1713 for the anchors and sutures are considered supplies.