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Turningpoint – Procedure Coding and Medical Policy Information

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Turningpoint – Procedure Coding and Medical Policy Information TurningPoint – Procedure Coding and Medical Policy Information TurningPoint Procedure Code Description Policy ACL Repair 27407 Repair, primary, torn ligament and/or capsule, knee; cruciate OR-1013 ACL Repair 27409 Repair, primary, torn ligament and/or capsule, knee; collateral and cruciate ligaments OR-1013 ACL Repair 29888 Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction OR-1013 Acromioplasty Or Acromionectomy, Partial, With Or Without Coracoacromial Ligament Acromioplasty and Rotator Cuff Repair 23130 OR-1018 Release Acromioplasty and Rotator Cuff Repair 23410 Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute OR-1018 Acromioplasty and Rotator Cuff Repair 23412 Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; chronic OR-1018 Acromioplasty and Rotator Cuff Repair 23415 Coracoacromial Ligament Release, With Or Without Acromioplasty OR-1018 Acromioplasty and Rotator Cuff Repair 23420 Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty) OR-1018 Arthroscopy, Shoulder, Surgical; Decompression Of Subacromial Space With Partial Acromioplasty and Rotator Cuff Repair 29826 Acromioplasty, With Coracoacromial Ligament (Ie, Arch) Release, When Performed (List OR-1018 Separately In Addition To Code For Primary Procedure) Acromioplasty and Rotator Cuff Repair 29827 Arthroscopy, shoulder, surgical; with rotator cuff repair OR-1018 Allograft for Spinal Fusion [BMP] 20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only OR-1005 Ankle Fusion 27870 Arthrodesis, ankle, open OR-1030 Ankle Fusion 29899 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with ankle arthrodesis OR-1030 Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate Cervical Disc Replacement 22856 preparation (includes osteophytectomy for nerve root or spinal cord decompression and OR-1006 microdissection), single interspace, cervical Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, Cervical Disc Replacement 22861 OR-1006 single interspace; cervical Cervical Disc Replacement 22864 Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical OR-1006 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, Cervical Laminectomy and Discectomy 63001 without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral OR-1007 segments; cervical Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, Cervical Laminectomy and Discectomy 63015 without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), more than 2 vertebral OR-1007 segments; cervical Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial Cervical Laminectomy and Discectomy 63020 facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, OR-1007 cervical Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial Cervical Laminectomy and Discectomy 63040 facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, OR-1007 single interspace; cervical Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, Cervical Laminectomy and Discectomy 63043 OR-1007 single interspace; each additional cervical interspace (List separately in addition to code for primary procedure) Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of Cervical Laminectomy and Discectomy 63045 spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single OR-1007 vertebral segment; cervical Cervical Laminectomy and Discectomy 63050 Laminoplasty, cervical, with decompression of the spinal cord, 2 or more vertebral segments OR-1007 Laminoplasty, cervical, with decompression of the spinal cord, 2 or more vertebral segments; Cervical Laminectomy and Discectomy 63051 with reconstruction of the posterior bony elements (including the application of bridging bone OR-1007 graft and non-segmental fixation devices (eg, wire, suture, mini-plates), when performed) Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including Cervical Laminectomy and Discectomy 63075 OR-1007 osteophytectomy; cervical, single interspace Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including Cervical Laminectomy and Discectomy 63076 OR-1007 osteophytectomy; cervical, each additional interspace Laminectomy and section of dentate ligaments, with or without dural graft, cervical; 1 or 2 Cervical Laminectomy and Discectomy 63180 OR-1007 segments Laminectomy and section of dentate ligaments, with or without dural graft, cervical; more than Cervical Laminectomy and Discectomy 63182 OR-1007 2 segments Cervical Laminectomy and Discectomy 63194 Laminectomy with cordotomy, with section of 1 spinothalamic tract, 1 stage; cervical OR-1007 Cervical Laminectomy and Discectomy 63196 Laminectomy with cordotomy, with section of both spinothalamic tracts, 1 stage; cervical OR-1007 Laminectomy with cordotomy with section of both spinothalamic tracts, 2 stages within 14 Cervical Laminectomy and Discectomy 63198 OR-1007 days; cervical Cervical Laminectomy and Discectomy 63250 Laminectomy for excision or occlusion of arteriovenous malformation of spinal cord; cervical OR-1007 Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; Cervical Laminectomy and Discectomy 63265 OR-1007 cervical Cervical Laminectomy and Discectomy 63270 Laminectomy for excision of intraspinal lesion other than neoplasm, intradural; cervical OR-1007 Cervical Laminectomy and Discectomy 63275 Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, cervical OR-1007 SuperiorHealthPlan.com SHP_20195259C TurningPoint Procedure Code Description Policy Cervical Laminectomy and Discectomy 63280 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, extramedullary, cervical OR-1007 Cervical Laminectomy and Discectomy 63285 Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, intramedullary, cervical OR-1007 Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or Cervical Laminectomy and Discectomy 0274T foraminotomy), any method, under indirect image guidance (eg, fluoroscopic, CT), with or OR-1007 without the use of an endoscope, single or multiple levels, unilateral or bilateral; cervical or thoracic Arthrodesis, anterior transoral or extraoral technique, clivus-C1-C2 (atlas-axis), with or without Cervical Spinal Fusion 22548 OR-1012 excision of odontoid process Arthrodesis, anterior interbody, including disc space preparation, discectomy, Cervical Spinal Fusion 22551 OR-1012 osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2 Arthrodesis, anterior interbody, including disc space preparation, discectomy, Cervical Spinal Fusion 22552 osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2, OR-1012 each additional interspace (List separately in addition to code for separate procedure) Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace Cervical Spinal Fusion 22554 OR-1012 (other than for decompression); cervical below C2 Cervical Spinal Fusion 22590 Arthrodesis, posterior technique, craniocervical (occiput-C2) OR-1012 Cervical Spinal Fusion 22595 Arthrodesis, posterior technique, atlas-axis (C1-C2) OR-1012 Cervical Spinal Fusion 22600 Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment OR-1012 Removal of prosthesis, includes debridement and synovectomy when performed; humeral and Elbow Replacement 24160 OR-1022 ulnar components Elbow Replacement 24164 Removal of prosthesis, includes debridement and synovectomy when performed; radial head OR-1022 Elbow Replacement 24360 Arthroplasty, elbow; with membrane (e.g., fascial) OR-1022 Elbow Replacement 24361 Arthroplasty, elbow; with distal humeral prosthetic replacement OR-1022 Elbow Replacement 24362 Arthroplasty, elbow; with implant and fascia lata ligament reconstruction OR-1022 Arthroplasty, elbow; with distal humerus and proximal ulnar prosthetic replacement (e.g., total Elbow Replacement 24363 OR-1022 elbow) Elbow Replacement 24365 Arthroplasty, radial head OR-1022 Elbow Replacement 24366 Arthroplasty, radial head; with implant OR-1022 Revision of total elbow arthroplasty, including allograft when performed; humeral or ulnar Elbow Replacement 24370 OR-1022 component Revision of total elbow arthroplasty, including allograft when performed; humeral and ulnar Elbow Replacement 24371 OR-1022 component Unlisted procedure, pelvis or hip joint [when specified as open procedure for Femoroacetabular Arthroscopy 27299 OR-1025 femoroacetabular impingement syndrome, other than capsular plication] Femoroacetabular Arthroscopy 29914 Arthroscopy, hip, surgical; with femoroplasty (ie, treatment of cam lesion) OR-1025 Femoroacetabular Arthroscopy 29915 Arthroscopy, hip, surgical; with acetabuloplasty (ie, treatment of pincer lesion) OR-1025 Arthroscopy, hip, surgical; with labral repair [when repair of the labral tear is associated
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