Coding and Reimbursement Guide for TenoGlide Tendon Protector Sheet 2018

Transcription

1 Coding and Reimbursement Guide for TenoGlide Protector Sheet 2018 Effective October 1, 2015, the Centers for & Medicaid Services (CMS) is implementing International Classification of Diseases, 10 th Revision (ICD-10) Procedure Coding System (PCS) in place of the 9 th Revision (ICD-9) procedure codes. CMS has provided a General Equivalence Mappings (GEMS) that crosswalk ICD-9 procedure codes to ICD-10 PCS (available at Below, Integra LifeSciences Corporation provides the mappings for select ICD-9 procedure codes. While Integra LifeSciences Corporation has used reasonable efforts to provide accurate coding information, this information should not be construed as providing clinical advice, dictating reimbursement policy, or substituting for the judgment of a practitioner. It is always the Provider s responsibility to determine and submit appropriate codes, charges, and modifiers for services that are rendered. Integra LifeSciences Corporation assumes no responsibilities or liabilities for the timeliness, accuracy, and completeness of the information contained herein. Since reimbursement laws, regulations, and payor policies change frequently, it is recommended that providers consult with their payors, coding specialists, and/or legal counsel regarding coverage, coding and payment issues. Potential Procedures Using TenoGlide Protector Sheet** in the Inpatient Setting ICD-9 Procedure ICD-10 PCS Root Operation ICD-9 Potential MS-DRG Assignment LQ Suture of Sheath of Hand , Repair/ Delayed suture of flexor of hand Delayed suture of other of hand Other Suture of Flexor of Hand Other Suture of Other of Hand LS Reposition/ LQ Repair/ LN Release/ Advancement of of hand , 906, Other tenodesis of hand , 906, Lysis of adhesions of hand 906, LQ Suture of Sheath , Repair/ Delayed suture of Other Suture of , LS Reposition/ Advancement of LM Reattachment/ Reattachment of , LQ Repair/, 0LM Reattachment/ LN Release/ Other Plastic Operations on , , , Lysis of adhesions of muscle,, fascia, and bursa

2 Potential MS-DRG s Using TenoGlide Protector Sheet** in the Inpatient Setting MS-DRG MS-DRG National Average 040 Peripheral/Cranial Nerve and Other Nervous System Procedures with MCC $22, Peripheral/Cranial Nerve and Other Nervous System Procedures with CC or Peripheral $14, Neurostimulator 042 Peripheral/Cranial Nerve and Other Nervous System $11, Procedures without CC/MCC 500 Soft Tissue Procedures with MCC $17, Soft Tissue Procedures with CC $10, Soft Tissue Procedures without CC/MCC $7, Hand or Wrist Procedures, Except Major Thumb or Joint Procedures with CC/MCC $9, Hand or Wrist Procedures, Except Major Thumb or Joint Procedures without CC/MCC $6, Other Skin, Subcutaneous Tissue and Breast Procedures with MCC $16, Other Skin, Subcutaneous Tissue and Breast Procedures with CC $10, Other Skin, Subcutaneous Tissue and Breast Procedures without CC/MCC $7, Hand Procedures for Injuries $10, Other O.R. Procedures for Injuries with MCC $25, Other O.R. Procedures for Injuries with CC $12, Other O.R. Procedures for Injuries without CC/MCC $8, Other O.R. Procedures for Multiple Significant Trauma with MCC $44, Other O.R. Procedures for Multiple Significant Trauma with CC $25, Other O.R. Procedures for Multiple Significant Trauma without MCC $16, Potential Procedures Using TenoGlide Protector Sheet** in the Hospital Outpatient/Ambulatory Surgical Center Setting Repair, or muscle, flexor, forearm and/or wrist; primary, single, each or muscle Repair, or muscle, flexor, forearm and/or wrist; secondary, single, each or muscle Repair, or muscle, extensor, forearm and/or wrist; primary, single, each or muscle Repair, or muscle, extensor, forearm and/or wrist; secondary, single, each or muscle Repair, sheath, extensor, forearm and/or wrist, with free graft (includes obtaining graft) (eg, for extensor carpi ulnaris subluxation) Tenolysis, flexor or extensor, forearm and/or wrist, single, each Tenodesis at wrist; flexors of fingers APC Weight 2018 Base Rate Hospital Outpatient 2018 Rate Ambulatory Surgical Center

3 Potential Procedures Using TenoGlide Protector Sheet** in the Hospital Outpatient/Ambulatory Surgical Center Setting cont Tenodesis at wrist; extensors of fingers Repair or advancement, flexor, not in zone 2 digital flexor sheath (eg, no man s land); primary or secondary without free graft, each Repair or advancement, flexor, in zone 2 digital flexor sheath (eg, no man's land); primary, without free graft, each Repair or advancement of profundus, w/ intact superficialis ; primary, each Repair, extensor, hand, primary or secondary; without free graft, each Repair, extensor, finger, primary or secondary; without free graft, each Tenolysis, flexor ; palm OR finger, each Tenolysis, flexor ; palm AND finger, each Tenolysis, extensor, hand OR finger, each Tenolysis, complex, extensor, finger, including forearm, each Repair, primary, open or percutaneous, ruptured Achilles Repair, secondary, Achilles, with or without graft Tenolysis, flexor or extensor, leg and/or ankle; single, each Tenolysis, flexor or extensor, leg and/or ankle; multiple s (through separate incision(s)) Repair,, flexor, foot; primary or secondary, without free graft, each Repair,, extensor, foot; primary or secondary, each Tenolysis, flexor, foot; single Tenolysis, extensor, foot; single APC Weight 2018 Base Rate Hospital Outpatient 2018 Rate Ambulatory Surgical Center $5, $2, $1, $287.28

4 Potential Procedures Using TenoGlide Protector Sheet** **- Physician Fee Schedule Work Value Unit Rate Repair, or muscle, flexor, forearm and/or wrist; primary, single, each or muscle Repair, or muscle, flexor, forearm and/or wrist; secondary, single, each or muscle Repair, or muscle, extensor, forearm and/or wrist; primary, single, each or muscle Repair, or muscle, extensor, forearm and/or wrist; secondary, single, each or muscle 8.04 $ $ $ $ Repair, sheath, extensor, forearm and/or wrist, with free graft (includes obtaining graft) (eg, for extensor carpi ulnaris subluxation) Tenolysis, flexor or extensor, leg and/or ankle; multiple s (through separate incision(s)) Tenodesis at wrist; flexors of fingers Tenodesis at wrist; extensors of fingers Repair or advancement, flexor, not in zone 2 digital flexor sheath (eg, no man s land); primary or secondary without free graft, each Repair or advancement, flexor, in zone 2 digital flexor sheath (eg, no man's land); primary, without free graft, each Repair or advancement of profundus, with intact superficialis ; primary, each Repair, extensor, hand, primary or secondary; without free graft, each Repair, extensor, finger, primary or secondary; without free graft, each Tenolysis, flexor ; palm OR finger, each Tenolysis, flexor ; palm AND finger, each Tenolysis, extensor, hand OR finger, each Tenolysis, complex, extensor, finger, including forearm, each Repair, primary, open or percutaneous, ruptured Achilles Repair, secondary, Achilles, with or without graft Tenolysis, flexor or extensor, leg and/or ankle; single, each Tenolysis, flexor or extensor, leg and/or ankle; multiple s (through separate incision(s)) 8.96 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $563.45

5 Potential Procedures Using TenoGlide Protector Sheet** Physician Fee Schedule and Non- Value Unit Rate Rate Non Repair,, flexor, foot; primary or secondary, without free graft, each Repair,, extensor, foot; primary or secondary, each Tenolysis, flexor, foot; single Tenolysis, extensor, foot; single 4.74 $ $ $ $ $ $ $ $ **Currently there are no procedure codes for the application of TenoGlide protector sheet for wrapping a. It is recommended that the following unlisted procedure codes be used to represent the application of TenoGlide protector sheet if trying to bill the wrapping of a as a procedure. When using an unlisted procedure code such as the codes provided below, it is necessary to provide supporting documentation when submitting the claim. Supporting documentation may include an Operative report or an Operative note Unlisted procedure, hands or fingers Unlisted procedure, leg or ankle Unlisted procedure, foot or toes HCPCS HCPCS C9356, porous matrix of cross-linked collagen and glycosaminoglycan matrix (TenoGlide Protector Sheet), per sq cm For assistance with coding and reimbursement, please contact our Integra Reimbursement Hotline at , option 3, option 2, Monday to Friday, 8 am to 6 pm, or via at reimbursement@integralife.com Reference: Book 2018, Current Procedural Terminology () copyright 2017 American Medical Association (AMA). All rights reserved. is a registered trademark of the AMA. Fee Schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. ICD-10-PCS codes and descriptors and DRG payment groups are effective October 1, TenoGlide, Integra and the Integra logo are registered trademarks of Integra LifeSciences Corporation in the United State and/or other countries Integra LifeSciences Corporation. All rights reserved. T ( )