For CY 2013, the CPT Editorial Panel has modified the descriptor for add on code +15777 and has limited this codes use to biologic implants placed into breast and/or trunk sites only. The new text is underlined below. The new descriptor and corresponding parentheticals are as follows:
15777 Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure)
(For implantation of biologic implants for soft tissue reinforcement in tissues other than breast and trunk, use 17999)
(For bilateral breast procedure, report 15777 with modifier 50)
(The supply of biologic implant should be reported separately in conjunction with 15777)
Specifically, the highlighted text notes changes which directly affect otolaryngology-head and neck surgeons. Providers implanting biologic implants for soft tissue reinforcement in areas such as the head or neck (such as implantation of Alloderm® into a parotidectomy wound bed) are now instructed to use the unlisted code CPT 17999 to report these procedures. Members should keep in mind that the unlisted code is not an add on code, as was +15777, which was previously reported. This means reimbursement for the unlisted code (17999) may be subject to a multiple procedure payment reduction.
As a reminder, unlisted codes do not have specific Medicare payment associated with them and are subject to the approval of local Medicare Administrator Contractors (MAC). Members should work directly with their local MAC to determine what reimbursement, if any, will be assigned to unlisted codes when supported with the necessary medical and diagnosis documentation. For additional guidance on reporting unlisted codes, access our new CPT for ENT at: http://bit.ly/CPT4ENT
Members seeking more information should contact the Academy’s Health Policy team.
Approved February 2013
Important Disclaimer Notice (Updated 8/7/14)
CPT for ENT articles are a collaborative effort between the Academy’s team of CPT Advisors, members of the Physician Payment Policy (3P) workgroup, and health policy staff. Articles are developed to address common coding questions received by the health policy team, as well as to clarify coding changes and correct coding principles for frequently reported ENT procedures. These articles are not intended as legal, medical, or business advice and are not a guarantee of reimbursement. The information is also not meant to serve as the definitive or sole authority on billing and coding issues. The applicability of AAO-HNS billing and coding guidance for a particular procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. You should consult with your own advisors as well as Medicare or private carriers in making any decisions about how to bill and code particular services or procedures.