AANA Position Statement on In-Office Arthroscopy

Diagnostic arthroscopy has been established as the gold standard for accurate identification of pathologies involving shoulder and knee joints. Several members have submitted questions to the Arthroscopy Association of North America (AANA) requesting guidance on proper coding of diagnostic arthroscopic procedures performed in the office setting using small-bore arthroscopic technologies. In response, the AANA Advocacy Committee and Board of Directors performed a thorough examination of the literature, reviewed advisory opinions from the AMA CPT Advisor, examined prior precedent from the Federal Registry and RUC and received input from industry stakeholders. Based on this comprehensive review, we believe it is appropriate to report Current Procedural Terminology (CPT®) codes 29805 (Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure)) and 29870 (Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)), when a comprehensive diagnostic procedure is performed in an office setting using small-bore arthroscopic equipment.

AANA’s Full In-Office Arthroscopy Position Statement (PDF)

Reimbursement Monograph

For more information on reimbursement monograph please see this resource.

Reimbursement Monograph for Orthopedic Surgeons

AANA’s Position Statement on Coding for Superior Capsular Reconstruction

Coding of arthroscopic superior capsular reconstruction (SCR) has been a recent topic of debate among surgeons and coding experts. According to a CPT® Advisor article published in April 2017, it was recommended that SCR be coded as an unlisted procedure using 29999.

We disagree with this conclusion. Further, given the high degree of surgical expertise required for this technique, we have great concern that this coding determination was not vetted by individuals with experience or an in-depth understanding of the pathology SCR treats.

AANA's Full Position Statement (PDF)

Reversal of NCCI edits citing shoulder as "single anatomic site"

In 2016, AANA leadership worked with CMS to formally unbundle the shoulder arthroscopic debridement codes. The unbundling of shoulder debridement codes allows AANA members to be compensated for additional work, when treating multiple surgical pathologies in the shoulder region. Despite this regulatory win, the 2017 NCCI coding manual still refers to the shoulder as “a single anatomic structure”. We believe that this language is anatomically inaccurate and may expose certain procedures to future reimbursement risk. It is vital that CMS recognize that the shoulder region contains distinct anatomic compartments, each with unique pathology and surgical treatment options. At the 2018 NOLC, AANA leadership submitted joint resolution with ASES, requesting that the AAOS recognize the shoulder to contain 5 distinct anatomic compartments: the glenohumeral joint, the subacromial space, the acromioclavicular joint. While this resolution serves a first step, work remains to change the language used by CMS, and the AANA Advocacy team will continue discussions with CMS on this important advocacy issue.

Non-coverage of HA injections by commercial insures

In the fall of 2017, AANA members reported increasing number of denials, by commercial insurance carries, related to use of Hyaluronic Acid (HA) injections for treatment of osteoarthritis of the knee. Many of these negative coverage determinations referenced the 2014 AAOS Clinical Practice Guidelines on treatment of Osteoarthritis of the Knee (non-arthroplasty), which came out with a recommendation against the use of HA. In responses to member concerns, we issued a survey to gain a better understanding of how these reimbursement decisions impact AANA members and their patients. The survey respondents overwhelmingly supported use of HA, for management in select patients with symptomatic osteoarthritis of the knee. Following the survey, AANA leadership discussed this issue with the AAOS leadership and detailed the concerns of our members. AANA leadership drafted a letter, outlining the scientific and clinical evidence supporting HA, and made it available to members for use in discussions with payers. Several state level discussions ensued, and to date, commercial insurers in Minnesota, North Carolina, South Carolina and Florida have reversed decisions in support of coverage for HA in select patient populations.

HA Survey Results

Viscosupplementation Insurance Letter

Working with AAOS on development of Clinical practice guidelines

The Arthroscopy Association of North America is committed to advancing the field of minimally-invasive orthopaedics and improving patient outcomes using evidence-based techniques. In recognition of our role as member representatives, AANA has nominated four of our members to participate in the AAOS CPG committee for: osteoarthritis of the knee (non-arthroplasty), management of rotator cuff problems, and Glenohumeral joint arthritis. Previously, our members voiced concerns that determinations by the AAOS CPG may have been used by payers to deny coverage for certain treatment options. Our goal is to work with the AAOS to ensure that updates to the CPG’s support the practice of evidence-based medicine, without limiting access to potentially useful treatment options.

Partnership with Department of Defense (DOD) for education of military orthopaedic surgeons

AANA recognizes the important work of our military members, and we believe that our educational programs should be offered in a manner that supports the unique time constraints of active duty service. AANA leadership created a program, designed specifically to support ongoing surgical skills training for active duty service members. This educational program has continued to grow, and we are currently in discussion with stakeholders in Washington, DC to secure funding to maintain and grow our military education program.

Does your group or practice have an issue or ongoing Advocacy concerns? AANA may be able to help. To contact our advocacy team, use email: advocacy@aana.org.

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