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03/14/2003    Matt Rockett, DPM

Billing For Osteo-Articular Transplant

RE: Billing For Osteo-Articular Transplant
From: Matt Rockett, DPM

I performed an osteo-articular transplant (I
harvested the graft locally from the foot) on a
2nd metatarsal head for a Grade II Freiberg's
infarction. I was going to use the code, CPT
20900 (bone graft, any donor area; minor or
small - e.g., dowel or button) for the harvest of
this graft.
The question comes in the coding of the second
metatarsal work.
I removed the osteophytes on both side of
the joint, and then removed the diseased area of
bone with the OATS system. Afterwards, I
implanted the graft. What suggestions are there
for the coding of what I did?

Matt Rockett, DPM
Houston, TX

Codingline-L Responses:

The surgery you described is quite unique,
and deserves individual consideration by peer
review in order to assure a fair compensation. I
think any existing codes would not capture the
procedure complexity, and fail to provide fair
CPT 20900 (bone graft, any donor area; minor
or small - e.g., dowel or button) seems
reasonable for the bone harvesting. I would then
recommend the use of CPT 28899 (unlisted
procedure, foot or toes) with a paper claim and a
copy of the operative report, requesting
individual peer consideration.

Howard Zlotoff, DPM- Codingline-L contributor
Camp Hill, PA

Since there is no CPT code to specifically
describe what you did, and since the OATS
procedure is considered by many payers to
be "experimental" even for the knee, I suspect
you'll have a difficult time obtaining
reimbursement for this case, unless you had prior
authorization for using the OATS type procedure.
So, if you're seeking reimbursement for the
cartilage portion of the graft as well as the
bone, you may be out of luck.
It sounds like the procedure was done
primarily to restore the infarcted bone while
reconstructing the joint, using the OATS
procedure as a means to supply both bone and
cartilage. While bone grafting is not
experimental, I think, in this case, the fact
that you harvested bone with cartilage is
relatively incidental. Placing a
corticocancellous graft with the intact cortical
surface articulating with the phalanx may have
accomplished the same goal.
Therefore, as an alternative, I might
suggest you avoid the term "OATS" and describe
the procedure as per CPT 28106 (excision or
curettage of bone cyst or benign tumor, tarsal or
metatarsal, except talus or calcaneus; with iliac
or other autograft - includes obtaining graft),
and perhaps also CPT 28270-51 (capsulotomy;
metatarsophalangeal joint, with or without
tenorrhaphy, each joint) - although it is
a "separate procedure" and may not be
independently reimbursed. I believe this
describes essentially what you did, but avoids
the OATS issue. Emphasize the bone graft rather
than the osteoarticular graft.

Paul Kosmatka, MD- Codingline-L contributor
Marshfield, WI

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