This tab is for other endoscopic procedures, in particular, Endoscopic Gastrocnemius Release (EGR), and Endoscopic Plantar Fasciitis Release (EPFR). There is no reimbursement issue with EPFR. There is a CPT code and there is no SOSD issue.
These can both be performed in an Office-Based Surgical Suite (OBBS) and use the same equipment as Endoscopic Carpal Tunnel Release (ECTR).
Four Downloads:
- How to report and negotiate for the unlisted EGR code (for the procedure) [Word document].
- The unlisted CPT code worksheet [Spreadsheet]
- Unlisted CPT code reimbursement Decision Tree (Visio Graphic)
- Cash payment Decision Tree outlining the issues (Visio Graphic)
If you have an OBSS set up for IOECTR, you could perform both foot and ankle procedures above if the surgeon is properly trained. The same endoscopic surgical device can be used for all three procedures. Check with your vendor for details
Issues
The issues with EGR and EPFR are different than with IOECTR. While both may be performed in an OBSS, that is a secondary issue.
There isn’t a specific CPT® code to report EGR, so you must report the procedure using:
29999: Unlisted procedure, arthroscopy.
Since this code has no fee schedule, the clinic must work up an overview of the procedure, estimated costs, and a fair reimbursement level and then contact the insurance company for an unlisted code carve-out. Some carriers will have an unlisted code policy and an unlisted code claim form. Below are two documents that will help you negotiate with a carrier a fair amount for an unlisted code.
29893: Endoscopic plantar fasciotomy.
There is a fee schedule for code 29893 above and it has an SOSD of 7 RVUs. In 2021, with a conversion factor of $32.41 the approximate NON-FAC PE reimbursement is $226.87. That is the payment for overhead, to the surgeon when the procedure is performed in an OBSS. There is no need for negotiation for a carve-out.