HIS Coding Updates

HIS Coding Updates

• Insurance Carrier Updates
• Coding Tip for Arthroscopic SLAP repair and Capsulorrhaphy

Aetna

Aetna has published a new precertification form for viscosupplementation.

UnitedHealthcare

• UHC will be requiring modifiers CT, FX, and FY modifiers on radiology

claims for Medicare Advantage beginning April 1, 2020 if they are applicable. The modifiers and explanations are as follows:

Modifier CT:

• CAT scans furnished on non-NEMA Standard XR-29-2013- compliant equipment
• Payment reduction of 15% will be applied to the technical component (TC) payment portion

Modifier FX:

• Imaging services that are X-rays taken using film
• Payment reduction of 20% will be applied to the TC payment portion

Modifier FY:

• Imaging services that involve cassette-based imaging which utilizes an imaging plate to create the image
• Payment reduction of 7% will be applied to the TC payment portion

Effective for claims with dates of service on or after April 1, 2020; we will implement reductions to the TC payment (and the TC portion of the global fee) portion of radiological services when appended with the CT, FX or FY modifiers.

Coding Tip for Arthroscopic Capsulorrhaphy (29806) and SLAP repair (29807)

Very often when arthroscopic capsulorrhaphy and SLAP repair are reported together for one operative session, the SLAP repair receives a denial because according to the Medicare claims edits SLAP repair is included in a capsulorrhaphy. Although getting Medicare to reimburse for both of these procedures, many other insurance carriers will reimburse for both services if the documentation clearly and completely describes each procedure. When the documentation supports separate work done in the superior and inferior areas of the shoulder, they will pay for both procedures. Clock positions are also helpful. This documentation is a good example for the operative report.

There was a type 2 SLAP tearing. The biceps itself, however, remained intact. The subcapsularis as well as remainder of the rotator cuff was intact. The anterior labrum was completely peeled off with obvious Bankart tearing present. He also had posterior labral tearing present, and this was essentially circumferential tearing. We then decorticated the bony surfaces for enhanced healing and used the tissue elevator to break up any early adhesion. We then proceeded with placing anchors at the 5,4, and 3 o’clock positions. These were all Arthrex anchors. Within the Bankart region, they were all knotless. We used the curved lasso to repair this labrum as well as for some capsulorrhaphy. He did have a Hills-Sachs lesion, however, it was not engaging. He did not significant bone loss. The superior labrum was then repaired. As mentioned, the bony surfaces had been repaired, and then we placed anchors at both the 11 and 1 o’clock positions, and firmly secured both anterior as well as posterior biceps anchor. We had excellent reduction of this tissue. This was again performed with the Arthrex knotless anchors. We then placed 3 additional SutureTaks posteriorly to secure the posterior labrum. These were placed through the posterior portal. We utilized 3 portals total. We had completely repaired all of the torn labrum.