2022 Coding and Reimbursement Guidelines for the ... - Arthrex
[Pages:3]2022 Coding and Reimbursement Guidelines for the Foot/Ankle Anchors Soft-Tissue Implants
To help answer common coding and reimbursement questions about arthroscopic procedures completed with the Foot/Ankle Anchors Soft-Tissue Implants, the following information is shared for educational and strategic planning purposes only. While Arthrex believes this information to be correct, coding and reimbursement decisions by AMA, CMS, and leading payers are subject to change without notice. As a result, providers are encouraged to speak regularly with their payers.
FDA Regulatory Clearance: The Arthrex SwiveLock? anchors are intended for fixation of suture (soft tissue) to bone in the foot/ankle in the following procedures: Lateral Stabilization, Medial Stabilization, Achilles Tendon Repair, Hallux Valgus Reconstruction, Midfoot Reconstruction, Metatarsal Ligament Repair/Tendon Repair, Bunionectomy. (K151342, March 24, 2016)
Value Analysis Significance: Soft-tissue anchor fixation has been a large part of Arthrex's success over the years. We have developed a multitude of anchor options across the foot and ankle platform. Arthrex is equipped to respond to customer needs by providing them with a portfolio of anchors that leverage our latest product innovations in sizing, versatility, and materials for all their patients and procedures.
Coding Considerations: Codes provide a uniform language for describing services performed by health care providers. The actual selection of codes depends on the primary surgical procedure, supported by details in the patient's medical record about medical necessity. It is the sole responsibility of the health care provider to correctly prepare claims submitted to insurance carriers.
Physician's Professional Fee: The primary arthroscopic procedure determined by the surgeon may include:
2022 Medicare National Average Rates and Allowables (Not Adjusted for Geography)
Physician2 Medicare National Average
Hospital Outpatient3
ASC4
CPT1 Code HCPCS Code
Code Description
Facility Setting (HOPD and ASC)
NonFacility Setting (Office)
APC and APC Description
Medicare National Average
Medicare National Average
Repair, Revision, and/or Reconstruction
Leg (Tibia and Fibula) and Ankle Joint
27650 27652 27654 27658
Repair, primary, open or percutaneous, ruptured Achilles tendon
$676.55
N/A
Repair, primary, open or
percutaneous, ruptured Achilles tendon; with graft
$675.17
N/A
(includes obtaining graft)
Repair, secondary, Achilles tendon, with or without graft
$731.23
N/A
Repair, flexor tendon, leg;
primary, without graft, each tendon
$378.25
N/A
5114 - Level 4 Musculoskeletal (MSK) Procedures
5114 - Level 4 MSK Procedures
5114 - Level 4 MSK Procedures
5113 - Level 3 MSK Procedures
$6,397.05 $6,397.05 $6,397.05 $2,892.28
$3,000.95 $3,905.12 $3,000.95 $1,361.61
27659
Repair, flexor tendon, leg;
secondary, with or without
$482.06
N/A
graft, each tendon
5114 - Level 4 MSK Procedures
$6,397.05
$3,000.95
27664
Repair, extensor tendon, leg;
primary, without graft, each
$375.13
N/A
tendon
5114 - Level 4 MSK Procedures
$6,397.05
$3,000.95
27665
Repair, extensor tendon, leg;
secondary, with or without
$433.96
N/A
graft, each tendon
5114 - Level 4 MSK Procedures
$6,397.05
$3,000.95
27675
Repair, dislocating peroneal
tendons; without fibular
$504.56
N/A
osteotomy
5113 - Level 3 MSK Procedures
$2,892.28
$1,361.61
1 CPT is the registered trademark of the American Medical Association. Healthcare providers and their professional coders must closely review this primary citation along with the patient's medical record before selecting the appropriate code.
2 Source: AMA CPT 2022 and CMS PFS 2022 Final Rule 3 Source: CMS 2022 OPPS Final Rule @ 4 Source: CMS 2022 ASC Final Rule @
Page 1 of 3
2022 Medicare National Average Rates and Allowables (Not Adjusted for Geography)
CPT1 Code HCPCS Code
Code Description
Repair, Revision, and/or Reconstruction
Leg (Tibia and Fibula) and Ankle Joint
Physician2
Medicare National Average
Facility Setting (HOPD and ASC)
Non-Facility Setting (Office)
27676 27690 27691 27692 27695
Repair, dislocating peroneal
tendons; with fibular osteotomy $624.64
N/A
Transfer or transplant of single
tendon (with muscle
redirection or rerouting); superficial (eg, anterior tibial
$657.52
N/A
extensors into midfoot)
Transfer or transplant of single
tendon (with muscle redirection
or rerouting); deep (eg, anterior
tibial or posterior tibial through
interosseous space, flexor
$764.10
N/A
digitorum longus, flexor hallucis
longus, or peroneal tendon to
midfoot or hindfoot)
Transfer or transplant of single
tendon (with muscle redirection
or rerouting); each additional
tendon (List separately in
$102.78
N/A
addition to code for primary
procedure)
Repair, primary, disrupted
ligament, ankle; collateral
$492.45
N/A
27696
Repair, primary, disrupted
ligament, ankle; both collateral $562.70
N/A
ligaments
27698
Repair, secondary, disrupted
ligament, ankle, collateral (eg,
$653.71
N/A
Watson-Jones procedure)
Repair, Revision, and/or Reconstruction
Foot and Toes
28200
Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon
$333.95 $508.71
28202 28208 28210 28238 28313
Repair, tendon, flexor, foot; secondary with free graft, each tendon (includes obtaining graft)
Repair, tendon, extensor, foot; primary or secondary, each tendon
Repair, tendon, extensor, foot; secondary with free graft, each tendon (includes obtaining graft)
Reconstruction (advancement), posterior tibial tendon with excision of accessory tarsal navicular bone (eg, Kidner type procedure)
Reconstruction, angular deformity of toe, soft tissue procedures only (eg, overlapping second toe, fifth toe, curly toes)
$435.00 $325.64 $426.35 $498.68 $366.13
$608.38 $494.87 $599.38 $686.59 $540.20
Hospital Outpatient3
ASC4
APC & APC Description
Medicare National Average
Medicare National Average
5114 - Level 4 Musculoskeletal (MSK) Procedures
5114 - Level 4 MSK Procedures
$6,397.05
$3,000.95
$6,397.05 $3,000.95
5114 - Level 4 MSK Procedures
$6,397.05
$3,000.95
Packaged service/item; no separate
payment made
5114 - Level 4 MSK Procedures
$6,397.05
Packaged service/item; no separate payment made
$3,000.95
5114 - Level 4 MSK Procedures
5114 - Level 4 MSK Procedures
$6,397.05
$3,000.95
$6,397.05
$3,000.95
5113 - Level 3 MSK Procedures
$2,892.28
$1,361.61
5114 - Level 4 MSK Procedures
5113 - Level 3 MSK Procedures
5114 - Level 4 MSK Procedures
$6,397.05
$3,000.95
$2,892.28
$1,361.61
$6,397.05
$3,000.95
5114 - Level 4 MSK Procedures
$6,397.05
$3,000.95
5113 - Level 3 MSK Procedures
$2,892.28
$1,361.61
Page 2 of 3
Hospital and Facility Coding
HCPCS Code
Code Description
C1713
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)
Anchor for opposing bone-to-bone or soft tissue-to-bone (C1713) ? Implantable pins and/or screws that are used to oppose soft tissue-to-bone, tendon-to-bone, or bone-to-bone. Screws oppose tissues via drilling as follows: soft tissue-to-bone, tendon-tobone, or bone-to-bone fixation. Pins are inserted or drilled into bone, principally with the intent to facilitate stabilization or oppose bone-to-bone. This may include orthopedic plates with accompanying washers and nuts. This category also applies to synthetic bone substitutes that may be used to fill bony void or gaps (ie, bone substitute implanted into a bony defect created from trauma or surgery.)
(List of Pass-Through Payment Device Category Codes ? Updated July 2020)
Notes
For Medicare, anchors/screws/joint devices are not separately reimbursed in any setting of care (eg, hospital, ASC, office). These costs are absorbed by the facility via the appropriate reimbursement mechanism (eg, MS-DRG, APC, etc).
For non-Medicare (e.g. Commercial) patients, depending on contractual terms and general stipulations of the payer, direct invoicing may be allowed. Contact the patient's insurance company or the facility's payer contract for further information.
For more information about the primary procedure, please speak with your admitting surgeon. You may also call Arthrex's Coding Helpline at 1-844-604-6359 or e-mail us at arthrex@.
This content is not intended to instruct medical providers on how to use or bill for health care procedures, including new technologies outside of Medicare national guidelines. A determination of medical necessity is a prerequisite that we assume w ill have been made prior to assigning codes or requesting payments. Medical providers should consult with appropriate payers, including Medicare fiscal intermediaries and carriers, for specific information on proper coding, billing, and payment levels for health care procedures.
The information provided in this handout represents no promise or guarantee concerning coverage, coding, billing, and payment levels. Arthrex specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on this information. It does not constitute legal advice and no warranty regarding completeness or accuracy is implied. The essential components that determine appropriate payment for a procedure or a product are site of service/coding/coverage/ payment system/geographical location/national and local medical review policies and/or payer edits.
? 2022 Arthrex, Inc. All rights reserved. OF1-000307-en-US_D Page 3 of 3
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