Coding and Reimbursement Guide for Integra Endoscopic ...

Coding and Reimbursement Guide for Integra? Endoscopic Gastrocnemius Release System (EGR) ? 2020

Disclaimer: While Integra LifeSciences Corporation intends to use 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.

Inpatient Setting

ICD-10 PCS Code 0LSN4ZZ

0LSP4ZZ

Code Description

Reposition Right Lower Leg Tendon, Percutaneous Endoscopic Approach Reposition Left Lower Leg Tendon, Percutaneous Endoscopic Approach

MS-DRG

MS-DRG Description

040

Peripheral/Cranial Nerve and Other Nervous

System Procedures with MCC

041

Peripheral/Cranial Nerve and Other Nervous

System Procedures with CC or Peripheral Neurostimulator

042

Peripheral/Cranial Nerve and Other Nervous

System Procedures without CC/MCC

500

Soft Tissue Procedures w/MCC

501

Soft Tissue Procedures w/CC

502

Soft Tissue Procedures without CC/MCC

Potential MS-DRG Assignment 040-042, 500-502, 579-581, 907-909, 957-959

Medicare National Average Payment $25,438.40

$15,109.56

$12,115.03

$20,271.41 $11,215.83

$8,553.60

MS-DRG

579 580 581

907 908 909 957 958 959

MS-DRG Description

Other Skin, Subcutaneous Tissue and Breast Procedures with MCC Other Skin, Subcutaneous Tissue and Breast Procedures with CC Other Skin, Subcutaneous Tissue and Breast Procedures without CC/MCC Other O.R. Procedures for Injuries with MCC Other O.R. Procedures for Injuries with CC Other O.R. Procedures for Injuries without CC/MCC Other O.R. Procedures for Multiple Significant Trauma with MCC Other O.R. Procedures for Multiple Significant Trauma with CC Other O.R. Procedures for Multiple Significant Trauma without MCC

Medicare National Average Payment $18,818.17 $10,285.78

$8,047.76

$25,433.90 $13,114.49

$8,837.05 $47,696.52 $27,029.83 $17,573.82

Hospital Outpatient/Ambulatory Surgical Center

CPT Code

Code Description

APC

Relative Weight

29999**

Unlisted procedure, arthroscopy

5111 2.8317

2020 Medicare Base Payment Rate ? Hospital Outpatient

$215.64

2020 Medicare Payment Rate ? Ambulatory Surgical Center

N/A

Physician Fee Schedule

CPT Code

Code Description

29999**

Unlisted procedure, arthroscopy

Relative Value Unit

N/A

2020 National Medicare Payment Rate Facility

N/A

**The CPT Advisory Panel has informed Integra LifeSciences Corporation that since there is not a specific CPT code for the procedure Endoscopic Gastrocnemius Recession, it is appropriate to code the procedure to CPT code 29999 - "Unlisted procedure, arthroscopy." When using an unlisted procedure code such as 29999, it is necessary to provide supporting documentation when submitting the claim. Supporting documentation may include an Operative report or an Operative note.

Also, there are no HCPCS codes associated with the use of the Integra? Endoscopic Gastroc Release System, which includes a single-use endoscope attachment and a disposable retracting blade.

For assistance with coding and reimbursement, please contact our Integra Reimbursement Hotline at 1-877-444-1122, option 3, option 2, Monday to Friday, 8 am to 6 pm, or via email at reimbursement@

Reference: CPT? Code Book 2020, Current Procedural Terminology (CPT) copyright 2019 American Medical Association (AMA). All rights reserved. CPT 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 CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The ICD-10 PCS codes and descriptors and DRG payment groups are effective October 1, 2020.

Integra is a registered trademark of Integra LifeSciences Corporation in the United States and/or other countries. ?2020 Integra LifeSciences Corporation. All rights reserved.

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1713211 ? 1 (2020-10)

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