Question 1

Helpful Codes For Cruciate Reconstruction With Allograft

Accepted Answer

Helpful Codes For Cruciate Reconstruction With Allograft

The following coverage, coding, and payment information is provided for informational purposes only and should not be construed as legal advice. The information was compiled from various resources and is subject to change.

Providers should exercise independent clinical judgment when selecting codes and submitting claims to accurately reflect the services rendered. Providers are encouraged to contact third-party payers for specific information on their coverage, coding, and payment policies as payment for medical products and services is affected by numerous factors.

Typical Medical Policy Guidelines for Cruciate Reconstruction with Allograft

Allograft ACL reconstruction is considered medically appropriate for an individual who is not a candidate for autogenous transplantation due to ANY ONE of the following:

Autogenous tissue has been compromised (e.g., by previous surgery, previous injury)
Multi-ligament reconstruction is being performed
Pathology such as chronic patellar tendonitis and hamstring injury exists

Ranges below indicate several options are available for the same procedure (e.g. left, right or bilateral).

Typical ICD-10 Codes

M22.2X1-M22.3X9 – Patellofemoral disorders and other derangements of patella
(including lateral, medial, anterior and posterior ligaments)
M22.8X1-M22.8X9 – Other disorders of patella (including lateral, medial, anterior and posterior ligaments)
M2

Question 2

Helpful Codes For Osteochondral Allograft Procedures In The Talus And Ankle

Accepted Answer

Helpful Codes For Osteochondral Allograft Procedures In The Talus And Ankle

The following coverage, coding, and payment information is provided for informational purposes only and should not be construed as legal advice. The information was compiled from various resources and is subject to change.

Providers should exercise independent clinical judgment when selecting codes and submitting claims to accurately reflect the services rendered. Providers are encouraged to contact third-party payers for specific information on their coverage, coding, and payment policies as payment for medical products and services is affected by numerous factors.

Ranges below indicate several options are available for the same procedure (e.g. left, right or bilateral).

Typical ICD-10 Codes

M24.171-M24.173 – Other articular cartilage disorders, ankle
M24.871-M24.873 – Joint derangement, ankle
M87.071-M87.076 – Idiopathic aseptic necrosis of ankle and foot
M87.171-M87.176 – Osteonecrosis due to drugs, ankle and foot
M87.271-87.276 – Osteonecrosis due to previous trauma, ankle and foot
M87.371-M87.376 – Other secondary necrosis, ankle and foot
M87.871-M87.876 – Other osteonecrosis, ankle and foot
M93.20 – Osteoarthritis of ankle
M93.271-M93.272, M93.279 –Osteochondritis dissecans, ankle and joints of foot
M93.871-M93.872, M93.279 – Other specified osteochondropathies, ankle
M94.8X7 – Other specified osteochondropathies, ankle

Typical ICD-10 Procedure Code

0

Question 3

Helpful Codes For Osteochondral Allograft Procedures In The Shoulder

Accepted Answer

Helpful Codes For Osteochondral Allograft Procedures In The Shoulder

The following coverage, coding, and payment information is provided for informational purposes only and should not be construed as legal advice. The information was compiled from various resources and is subject to change.

Providers should exercise independent clinical judgment when selecting codes and submitting claims to accurately reflect the services rendered. Providers are encouraged to contact third-party payers for specific information on their coverage, coding, and payment policies as payment for medical products and services is affected by numerous factors.

Letter of Medical Necessity

Shoulder resurfacing procedures are considered the best option for specific patients. However, because they are not done in high volume, there have been few high-level outcomes published to date. As a result, health plans are challenged to develop broad, positive coverage determinations for these procedures.

In order to obtain coverage and reimbursement for specific patients indicated for these procedures, the physician typically will need to use the CPT code for an unlisted procedure (see below) and craft a letter to the payer describing the patient’s clinical situation. The letter should clearly detail why this course of action is the most appropriate treatment alternative.

Often it is useful to reference more commonly performed and somewhat similar shoulder surgeries, with an explanation of the adde

Question 4

Sending Files to a Compressed Folder on a PC

Accepted Answer

Sending Files to a Compressed Folder on a PC

Place disc in computer CD-Rom. Typically, a window similar to the one below will pop up. Select “Open folder to view files”:

Select “Open folder to view files”

Once the folder is open it should look similar to the screen below:

Using your mouse, LEFT click one time on any single file in the folder. Once a file is selected, hit CTRL + A on your keyboard to highlight ALL of the files on the disc:

Next, place your cursor over the highlighted area and RIGHT click one time. It will bring up a menu with an option to select “Send to”. Click on the “Send to” option and then select “Compressed (zipped) folder” in the subsequent menu:

The message below will frequently appear when compressing files from a disc. Just click “Yes” here and the files will begin compressing onto a new zip file on your DESKTOP.

Your screen should bring up a status window similar to the one below:

![](https://storage.crisp.chat/users/helpdesk/website/cfffcfbd3c187800/pict

Question 5

Helpful Codes For Allograft Meniscus Reconstruction

Accepted Answer

Helpful Codes For Allograft Meniscus Reconstruction

The following coverage, coding, and payment information is provided for informational purposes only and should not be construed as legal advice. The information was compiled from various resources and is subject to change.

Providers should exercise independent clinical judgment when selecting codes and submitting claims to accurately reflect the services rendered. Providers are encouraged to contact third-party payers for specific information on their coverage, coding, and payment policies as payment for medical products and services is affected by numerous factors. Ranges below indicate several options are available for the same procedure (e.g. left, right or bilateral)

Typical Medical Policy Guidelines for Meniscus Allograft Reconstruction

Many health plans consider meniscus allograft transplantation of the knee a medically necessary treatment when specific criteria are met. The list below includes many of the criteria considered by health plans. Providers should consult the patient’s third-party payer’s Medical Policy for a complete list.

Skeletally mature up to and including age 55 years; and
Disabling knee pain refractory to conservative treatment; and
Ligamentous stability prior to surgery or achieved concurrently with meniscus transplantation; and
Documented mild to moderate articular damage (Outerbridge grade II or less); and
BMI ≤ 35; and
Normal alignment without varus

Question 6

Helpful Codes For Osteochondral Allograft Procedures In The Distal Femur

Accepted Answer

Helpful Codes For Osteochondral Allograft Procedures In The Distal Femur

The following coverage, coding, and payment information is provided for informational purposes only and should not be construed as legal advice. The information was compiled from various resources and is subject to change.

Providers should exercise independent clinical judgment when selecting codes and submitting claims to accurately reflect the services rendered. to individual patients. Providers are encouraged to contact third-party payers for specific information on their coverage, coding, and payment policies as payment for medical products and services is affected by numerous factors.

Ranges below indicate several options are available for the same procedure (e.g. left, right or bilateral).

Typical ICD-10 Codes

M12.561-M12.569 – Traumatic arthropathy
M17.0-M17.9 – Osteoarthritis of knee, degenerative joint disease
M22.90-M22.93 – Unspecified disorder of patella
M23.50-M25.369 – Chronic instability, flail joints
M23.000-M23.92 – Internal derangement of knee
M23.8X1-M23.8X2 – Other internal derangements of knee
M25.561-M25.569 – Pain in knee
M87.051-M87.059 – Idiopathic aseptic necrosis of femur
M87.151-M87.159 – Osteonecrosis due to drugs, femur
M87.251-M87.256 – Osteonecrosis due to previous trauma, femur
M93.261-M93.269 – Osteochondritis dissecans of knee
M93.861-M93.869 – Other specified osteochondropathies of lower leg
M94.261-M94.262 – Chondromalacia
M94

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