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Wrist Fusion

Diane Posted Mon 18th of March, 2019 15:03:56 PM
My doctor wrote an order for Fusion of radiocarpal joint. The code 25800 would be perfect except it says without bone graft. He is going to use bone and I have looked at 20932. Can I use 25800 since he is using bone graft and it specifically states without bone graft? Can I add a -22 to it? Is there a code that I am missing for fusion of radiocarpal joint that I am missing? Can I bill 25800-22 and 20932? Thank you.
SuperCoder Answered Tue 19th of March, 2019 07:23:28 AM

Hello Diane,

Thank you for your question.

 

CPT® code 25800 states: Arthrodesis, wrist; complete, without bone graft.

Your suggested code 20932 is an ‘add on’ code for which a primary code is required. The primary code for CPT® code 20932 does not include CPT® code 25800.

 

As per the provided documentation, if the doctor uses a bone graft, there are certain CPT® code which includes the graft in the main code descriptor. i.e. 25805, 25810 or 25825.

 

The codes which includes the graft in the main procedure should not be reported additionally with graft codes. Also, to report modifier-22, your medical documentation should support the appropriate usage of appending modifier-22 (Increased Procedural Services); i.e. Increased intensity, time, technical difficulty of the procedure, severity of patient's condition, physician and mental effort required.

 

When your provider performs a complete wrist arthrodesis, she’ll also sometimes perform a bone graft. When this occurs, you’ll report 25810 for an autograft, and 25805 for a sliding bone graft.

 

The autograft, is the most common graft for wrist arthrodesis, occurs when the surgeon fuses wrist joints together using a bone graft harvested from the patient.

 

For more information, kindly go through the under-mentioned link. Do let us know, in case you’re unable to access the newsletter.

https://www.supercoder.com/coding-newsletters/my-orthopedic-coding-alert/surgery-write-off-wrist-arthrodesis-coding-worries-with-this-advice-160297-article

 

Hope that helps.

 

Thanks

Please feel free to write if you have any question.

Diane Posted Tue 19th of March, 2019 11:02:49 AM
Thank you for your response but I still have a problem. 25805 is with sliding graft he said he is not doing a sliding graft. 25810 is with iliac or other autograft, he is not taking bone from the iliac and not using an autograft from anywhere else. He is using bone bank bone or DBM/croutons. So he is not using an autograft at all, I guess it would be considered an allograft but all the allograft codes state for spine surgery. I hate to use an unlisted procedure. Any further suggestion for this procedure when not using bone harvested from the patient? I did review the link that you provided but it did not address the issue either when the surgeon does not use bone harvested from the patient and uses bone provided from elsewhere.
SuperCoder Answered Wed 20th of March, 2019 08:17:10 AM

Hello Diane,

Thank you for the additional information.  

 

Since, your provider is using an allograft (bone bank bone or DBM/croutons); there is no specific CPT® code available for fusion of radiocarpal joint with allograft, you are advised to report an unlisted procedure with CPT® code 25999 (Unlisted procedure, forearm or wrist).

 

Thanks.

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