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Volume I August 10th, 2017
  Coding Corner Newsletter

Aetna - Clinical Policy Bulletin
Arthroscopic Meniscectomy 
(CPT 29880 - 29881)  
Does it meet medically necessary guidelines for payment?
Aetna considers arthroscopic meniscectomy (29880 & 29881) medically necessary for traumatic meniscal tears. Aetna considers arthroscopic meniscectomy experimental and investigational for degenerative meniscal tears and derangement due to old tear or injury.

Are you destroying spinal and peripheral nerves at less than 80 degrees Celsius?

If you are, you may be losing money!
The AMA and Medicare have specific guidelines that destruction by neurolytic agent of facet joint nerves and peripheral nerves done at less than 80 degrees Celsius are to be coded with unlisted code 64999 instead of code range 64633-64636, 64640. *Correction was made. Original newsletter contained a typo which listed 64490-64495. We apologize for any confusion.

Medicare does not pay for unlisted procedure codes.

Documentation in the pain note must include the Celsius degrees used.
Nasal Endoscopy, Eustachian Balloon Dilation

C9745 - Code effective July 1, 2017
  Effective July 1, 2017 the Centers for Medicare & Medicaid Services (CMS) established a temporary code, C9745, to describe Eustachian Tube Balloon Dilation. Prior to July 1, 2017 this was billed out with unlisted code 69799.

Medicare ASC Fee Schedule
$2,896.99 - Unilateral
$4,345.49 - Bilateral 


Entellus C9745 News Article
CPT code 63267 has a C5 Payment Indicator (inpatient procedure) for Medicare, therefore not payable in an ASC.  
Synovial Cyst Removal with Laminotomy and Foraminotomy use code 63267
AMA Inquiry June 30, 2017:
The patient had left L5-S1 foraminal stenosis and L5-S1 synovial cyst. A Laminotomy and Foraminotomy with decompression and excision of synovial cyst at L5-S1 level was performed. What would be the appropriate CPT code for this situation, CPT 63047 or 63267?

AMA Response:
From a coding perspective, the appropriate code to report is  63267, Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; lumbar. CPT 63047, Laminectomy, facetectomy and Foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equine and/or nerve root(S); lumbar do not include the work done to remove lesions/cysts.
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