Coding, Classification & Reimbursement

AMA OR AAOS

  • 1.  AMA OR AAOS

    Posted 02-09-2018 13:36
    ​When coding for a hospital, and this is for a private payer, do you code based on AMA/CCI edits, or AAOS ( for an orthopedic surgery)
    For example, coding an arthroscopic claviculectomy.
    Based on the CPT book there are no instructions on the size being excised.
    29824 - distal claviculectomy including distal articular surface

    Based on AAOS
    It also is appropriate to code separately for excision of the distal clavicle, if this is done in either an open or arthroscopic procedure. This means excision of the entire distal clavicle (approximately 1 cm), not merely shaving off osteophytes at the acromioclavicular joint

    After a recent audit I was notified that the payer, based on AAOS, denies the 29824, since the surgeon didn't specify the size of the excised clavicle.
    Any help would be appreciated.
    thanks​

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    Rivona Wasserman
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  • 2.  RE: AMA OR AAOS

    Posted 02-13-2018 15:04
    Hello Rivona,

    At one of the hospitals I worked, we were instructed to follow CMS' NCCI Guidelines.  If the documentation clearly states bone was removed (29824) and not just debridement (29822/29823) was done, then it would be appropriate to report 29824.  Unfortunately, CPT nor CMS does not specify bone size, so a query may be appropriate if the procedure title states "distal claviculectomy" but the description in the body of the op report does not match/support the title.  It seems the payer in your situation is following an older AAOS guidelines. A 2017 article by an AAPC member states that as of 2010 the size reference was removed from AAOS publishings.

    Hope this helps.

     



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    Cristina Co
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