You Be the Coder: Fulkerson Procedure- Published on Sun, Oct 01, 2000
Question: Please advise on the use of codes 27418 and 27425. How should I bill for the Fulkerson procedure with a lateral release? Can I bill for the chondroplasty with both procedures?
Fair Lawn, N.J.
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Unfortunately, if you report 27418 (anterior tibial tuberclepasty [e.g., Maquet type procedure]) and 27425 (lateral retinacular release [any method]) together, the insurance carrier will deny payment for 27425 on the basis that it is a component of 27418. According to the Complete Global Services Data for Orthopaedic Surgery published by the American Academy of Orthopaedic Surgeons, a lateral retinacular release (27425) is included in the global service package of an anterior tibial tubercleplasty (27418). The Medicare Correct Coding Initiative (CCI) also lists 27425 as a component of 27418.
Your local Medicare carrier can tell you where to obtain a copy of the CCI. This manual provides you with most of the bundling edits used by Medicare when processing claims. Beware though, Medicare also uses a separate list of unpublished code edits, often referred to as black box edits. So even if the CCI indicates that two codes can be reported together, they may not pass the black box edits, and you may still find your codes rebundled. Complete Global Services Data for Orthopaedic Surgery is available through the American Academy of Orthopaedic Surgeons at (800) 626-6726 or firstname.lastname@example.org.
Source for You Be the Coder is Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant and educator based in North Augusta, S.C.