Zimmer® Patient Specific Instruments
Overview
The Zimmer Patient Specific Instruments Reimbursement Kit is intended to provide reference material related to general guidelines for the reimbursement of the Zimmer Patient Specific Instruments when used consistently with the product’s labeling. The Reimbursement Kit includes information regarding coverage , coding and payment as well as guidance regarding insurance verification, prior authorizations and appeals .
Zimmer offers additional reimbursement resources and tools for orthopedic products and procedures including the Zimmer Reimbursement Hotline, which provides live coding information via dedicated reimbursement specialists. Hotline support is available 9 am to 8 pm Eastern Time, Monday through Friday at (866) 946-0444.
All Zimmer reimbursement resources are also available at our web site: www.reimbursement.zimmer.com
Product Description
Zimmer Patient Specific Instruments are disposable, patient-matched, pin placement guides for the femur and tibia for use during total knee replacement procedures. They are based on each individual patient’s mechanical axis alignment and follow the principles of traditional measured resection. The Zimmer Patient Specific Instruments are manufactured per the specific surgery plan.
Pre-operatively, the surgeon determines the implant type and size to be used on the patient, which allows for pre-operative preparation of only the appropriately sized specific instruments required for the femur and tibia implant placement.
An additional benefit of Zimmer Patient Specific Instruments design is the intra-operative flexibility to adjust the resection level used in conjunction with Zimmer’s conventional cut guides.
Magnetic Resonance Imaging (MRI)
Zimmer Patient Specific Instruments require a patient MRI to be obtained pre-operatively to capture the patient’s anatomy from hip to ankle, which is critical for reconstructing the mechanical axis. This MRI data is converted into a three dimensional (3D) model of the patient’s unique anatomy.
The Zimmer Patient Specific Instruments surgeon planning software is a 3D tool that allows for pre-operative decision making of the surgical plan. Utilizing this software, surgeons may view and make any changes to the standard plan defaults including preferred implant size, resection level, varus/valgus, flexion/extension, slope, etc. Surgeons also have the ability to view bone cuts and implant overlays allowing for the visualization in 3D the effects that adjustments to the surgical plan will have on the patient. For example, the surgeon can interpret overhang and adjust the implant/implant size accordingly.
Summary of Patient Indications
The Zimmer Patient Specific Instruments are utilized during total knee arthroplasty (TKA). The primary indication for total knee arthroplasty is to relieve pain caused by arthritis.
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Download Complete Reimbursement Kit PDF |
Reimbursement Kit Chapters
Payer Coverage
Insurance Verification Process
Prior Authorization
Coding
Guidance
Appeals
FAQs
Sample Letters
Zimmer® Patient Specific Instruments - Disclaimer
The information presented in this reimbursement kit is intended for informational purposes only, and nothing herein is advice, legal advice or a recommendation of any kind, and it should not be considered as such. The coding and coverage information in this reimbursement kit was obtained from third party sources and is subject to change without notice, including as a result in changes in reimbursement laws, regulations, rules and policies. Reimbursement kit content is informational only, general in nature, and does not cover all situations or all payers' rules or policies, and is not intended to apply to any care of the patient to support reimbursement. Providers should report the procedure and related codes that most accurately describe the patient's medical condition, procedures performed and the products used. The information presented in this reimbursement kit represents no promise or guarantee from Zimmer regarding coverage or payment for products or procedures by Medicare or other payers. Providers should check Medicare bulletins, manuals, program memoranda, and Medicare guidelines to ensure compliance with Medicare requirements. Inquiries can be directed to the hospital's Medicare part A fiscal intermediary, the physician's Medicare part B carrier, the applicable Medicare administrative contractor, or to appropriate payers. Zimmer specifically disclaims liability or responsibility for the results or consequences of any actions taken in reliance on information presented in this reimbursement kit. Additionally, the information provided in this reimbursement kit should not be misconstrued as advertising or promotion. Zimmer neither promotes nor advocates off-label use of any Zimmer product. Please consult the product literature supplied with Zimmer products to determine intended use.
This Reimbursement Kit is effective December 1, 2009
