Q: Are screws, SutureTak® anchors, Bio-Composite™ screws, SwiveLocks® anchors, PushLocks® anchors, Pec or Dog Bone Buttons considered implants or anchors? What HCPCS code options are available to bill the private commercial insurer?
A: HCPCS C1713. Yes. Those products are considered implants or anchors. The appropriate HCPCS code for billing the private commercial insurer is C1713 (Anchor/screw for opposing bone-to-bone or soft tissue-to-bone [Implantable]), 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 - orthopedic plates with accompanying washers and nuts and synthetic bone substitutes that may be used to fill bony void or gaps (ie, bone substitute implanted into a bony defect created from trauma or surgery).
Q: Are SutureLasso™ suture passers, FiberWire®/TigerWire® sutures billable? If so, what HCPCS is required?
A: Yes. These products are billable but should be coded as supplies since there is not a unique HCPCS code for sutures.
Q: What HCPCS code is appropriate when billing for instruments, Scorpion™ needles or positioners?
A: There is not a specific HCPCS code for these products. They are considered supplies or instruments, and should be coded as such.
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 code 04125 is used to report ArthroFLEX®* dermal allograft product. The ArthroFLEX graft was removed from the Medicare skin substitute graft product list of high-/low-cost products as of January 1, 2016. The HCPCS code 04125 still exists for reporting other uses of the product such as in soft tissue procedures. Some private commercial payers 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 or C9399, 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 dermal allograft.
Q: What CPT code do you suggest for Complete Plantar Plate Repair (CPR)?
A: CPT codes 28285, 28308, 28270 or 28899 (unlisted) may be appropriate for documenting this repair. 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: Is there a description of the Arthrex ACP® system? What code would you recommend?
A: The Arthrex ACP double-syringe system 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 system and applied at the point-of-care. Autologous conditioned plasma (ACP) can be mixed with autograft and allograft bone prior to application at an orthopedic surgical site as deemed necessary by the clinical use requirements. The recommended CPT code is 0232T.
Q: How can we understand the coding pathway options for BioCartilage® extracellular matrix and Cartiform®‡ viable osteochondral allograft 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 JumpStart® single layer dressing?
A: JumpStart wound dressing is coded as a supply.
Q: Is there a HCPCS code associated with your SpeedBridge™ implant system?
A: The anchors are reportable and the FiberWire sutures are classified as such. HCPCS C1713 should be used for the implant.
Q: Is there a recommended HCPCS code for StimuBlast®§ demineralized bone matrix?
A: StimuBlast matrix 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 the TightRope® Repair Kit (AR-2257)?
A: The kit contains two anchors that are reportable and FiberWire/TigerWire sutures. The HCPCS code is C1713 for the anchors and sutures are considered supplies.
*ArthroFLEX is a registered trademark of LifeNet Health.
†CPT is a registered trademark of the American Medical Association.
‡Cartiform is a registered trademark of Osiris Therapeutics, Inc.
§ StimuBlast is a registered trademark of AlloSource.