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Arthrodesis With Local Graft
What is the appropriate CPT code to report when local autograft is used and taken from the reamings and allograft is used for arthrodesis of the IP joint? Which CPT code is correct, 26862 or 26860?
Question:
What is the appropriate CPT code to report when local autograft is used and taken from the reamings and allograft is used for arthrodesis of the IP joint? Which CPT code is correct, 26862 or 26860?
Answer:
Thank you for your question.
CPT 26860 includes using locally obtained autograft bone in addition to the allograft. In contrast, CPT code 26862 is reported when an autograft is obtained from a separate site and is valued for the additional work involved in obtaining that graft from a separate anatomical location.
Based on the question and presented scenario, the correct CPT code is 26860.
*This response is based on the best information available as of 4/24/25.
Bioinductive Implants
When providers use bioinductive implants to reinforce rotator cuff repairs or other musculoskeletal procedures, what is the best way to report them? CPT code 17999 is often suggested, but CPT Assistant references imply that this unlisted code should only be reported with codes in the integumentary system.
Question:
When providers use bioinductive implants to reinforce rotator cuff repairs or other musculoskeletal procedures, what is the best way to report them? CPT code 17999 is often suggested, but CPT Assistant references imply that this unlisted code should only be reported with codes in the integumentary system.
Answer:
Thank you for your inquiry. CPT code 17999 is an unlisted code for the integumentary system. It is used for procedures performed on skin, mucous membranes, and subcutaneous tissue and is not appropriate for use with these procedures.
The bioinductive implant or patch is usually secured with small anchors or sutures to position it correctly on the tendon, provide mechanical support, and enhance biological healing after an arthroscopic rotator cuff repair. This is not a normal part of a standard rotator cuff repair, and therefore, with supporting documentation, KZA recommends CPT code 29827 with modifier 22 for increased procedural service. There is no additional reporting for the biologic implant on the surgeon’s professional claim; however, the ASC or hospital could report the implant on the facility claim.
*This response is based on the best information available as of 4/10/25.
Cast Overwrapping
Can a practice report a CPT code for a cast application code if they only place a fiberglass overwrapping to current cast?
Question:
Can a practice report a CPT code for a cast application code if they only place a fiberglass overwrapping to current cast?
Answer:
The practice will report a supply code only if the old cast was not removed and replaced but only had additional wrapping placed.
An example may be the overwrapping of a previously applied bivalved cast. The practice would not report a new cast application code but may report the supply code.
*This response is based on the best information available as of 3/27/25.
Physician Assistant Billing for New and Established Patients
Our Physician Assistant saw a new Medicare Patient in the office for evaluation of left knee pain. She evaluated the patient and developed the plan of care. The patient was scheduled for a return visit with the Physician Assistant. During the return visit, the Physician Assistant evaluated the patient and made no changes to the plan of care—she continued the NSAIDs as the patient responded well.
Can she bill this “Incident to” the physician who was in the office, as there was no change in the plan of care?
Question:
Our Physician Assistant saw a new Medicare Patient in the office for evaluation of left knee pain. She evaluated the patient and developed the plan of care. The patient was scheduled for a return visit with the Physician Assistant. During the return visit, the Physician Assistant evaluated the patient and made no changes to the plan of care—she continued the NSAIDs as the patient responded well.
Can she bill this “Incident to” the physician who was in the office, as there was no change in the plan of care?
Answer:
Thanks for your inquiry. Although the second visit involves an established patient with no changes to the plan of care or new orders, the Physician Assistant must submit the claim as the service provider. The 'Incident to' requirements have not been met.
To move this to an “Incident to” encounter, there must be an independent encounter with the physician who either agrees with or changes the plan of care. After the physician independently evaluates the patient and either agrees with or modifies the plan of care, subsequent encounters with the Physician Assistant may be reported as 'Incident to' if the requirements are met (e.g., implementation of the plan of care without new orders or changes to the plan of care).
*This response is based on the best information available as of 3/13/25.
Bone Marrow Harvest for Ankle Arthrodesis
Our surgeon harvested bone from the calcaneus (same incision) and also harvested bone marrow from the iliac crest for an ankle arthrodesis. We know the bone graft from the calcaneus is not reportable. Is the bone marrow aspirate reportable? If yes, what CPT code do you recommend?
Question:
Our surgeon harvested bone from the calcaneus (same incision) and also harvested bone marrow from the iliac crest for an ankle arthrodesis. We know the bone graft from the calcaneus is not reportable. Is the bone marrow aspirate reportable? If yes, what CPT code do you recommend?
Answer:
You are correct that bone graft harvested via the same incision is not separately reportable. CPT instructs to report 20999 for the bone marrow harvest when performed for an arthrodesis in musculoskeletal system, excluding spine.
Based on your inquiry the correct code for the ankle arthrodesis is 27870 (Arthrodesis, ankle, open). Your reportable codes are 27870 and 20999.
Note, there are no NCCI edits between 27870 and 20999. Consider adding modifier 59 if necessary to indicate the bone marrow aspirate was from a different location, separate incision.
KZA recommends using 20939 as the comparison code for 20999.
*This response is based on the best information available as of 2/27/25.
7th Character for Cast Re-application
We are a bit confused about what 7th character code we should use when the patient is being seen in follow-up for a fracture. The initial encounter was reported with the “7th character” for the initial evaluation and application of cast or splint. When the patient returns and the surgeon re-applies a new cast, do we use the 7th character code for active treatment or the 7th character code for routine healing?
Question:
We are a bit confused about what 7th character code we should use when the patient is being seen in follow-up for a fracture. The initial encounter was reported with the “7th character” for the initial evaluation and application of cast or splint. When the patient returns and the surgeon re-applies a new cast, do we use the 7th character code for active treatment or the 7th character code for routine healing?
Answer:
Thank you for your inquiry. You are not alone in your confusion even 8 years after ICD 10 was implemented. You are correct to use the “initial treatment” (sometimes referred to as the active treatment) code for the initial evaluation of the patient. If the treatment plan is to apply a cast, and the patient returns, they are stable, healing has begun, the correct 7th character code for the fracture will be the “routine healing or follow-up care.”
Other examples of when you might use the 7th character for routine healing/subsequent encounter, in addition to the cast/splint re-application, are:
· Dressing change or removal
· Staple or suture removal
· Removal of external or internal fixation device
Some of the confusion stems from references to “initial” treatment and “active” treatment.
ICD identifies the 7th character, based on the location and type of fracture, to be:
Initial
Routine
Delayed
Nonunion
Malunion
*This response is based on the best information available as of 2/13/25.