august 2015

Category III Code for Arthroereisis

I felt it was necessary to repeat this newsletter because in the past week we have two instances where ASC’s did not receive reimbursement due to the fact that one of the cases was precertified as a dislocation treatment and the second case was precertified as a subtalar arthrodesis.

 

Flatfoot deformity is a common condition that can be either congenital or an acquired deformity. When you look at the inside portion of the midfoot you will notice that there is an arch in the foot. What happens with some people is that during weight bearing (standing with pressure being put on the joint) the talus will displace anteriorly and medially in a downward motion which causes the arch to collapse. In order to correct this condition the physician must stabilize the subtalar joint between the talus and calcaneus to prevent displacement of the talus and this accomplished by inserting an implant into the subtalar joint. The most common types of implants are the MBA (Maxwell-Brancheau Arthroereisis), HyProCure and Solana subtalar Implants. The implant looks like a large threaded screw. Placement of these implants is usually performed by making a small incision on the lateral side of the foot along with placement of a guide wire through the subtalar joint. The implant is then placed over the guide wire and advanced until seated at the subtalar joint and then screwed into place.

 

Category III code 0335T – Extra-osseous subtalar joint implant for talotarsal stabilization – should be reported for this procedure.

 

Note the term “EXTRA-OSSEOUS” in the code description with “EXTRA” meaning located or occurring outside of the bone. In an arthroereisis the implant is placed within the subtalar joint “outside” of the bone to stabilize the joint. In an arthrodesis the screws or implants would be placed through at least two bones (intraosseous) to fuse the joint so that there is no movement within that joint.

 

In addition, CPT Assistant Sept. 2011 clarifies the use of a dislocation treatment by stating that this would be a “misrepresentation” of this code set because there is no anatomical evidence of a complete joint disruption/dislocation when using this type of implant.

 

Reimbursement for an arthrodesis or dislocation treatment is more than twice that of the arthroereisis, so I can see the want for precertifying one of those codes, but that leads to no reimbursement for the ASC when coded correctly due to not matching the authorized code. Educate your physicians by making them aware of Category III code 0335T and its use so that your ASC can avoid a potential claims denial.

 

 







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