Orthopedic Coding Alert

Read policies carefully for OATS, mosaicplasty procedures Knee surgery remains one of the top procedures for orthopedic surgeons, but coders can find it difficult to navigate the codes for new procedures and for combination surgeries. If you could use a quick knee coding primer, we-ve got just the information you need.
 
You Can Report ACL Repair With Meniscectomy Patients who suffer complex sports injuries often present with a combination of problems. Your surgeon might repair not just the medial or lateral meniscus but also ligament injuries. The good news is that you can usually report both procedures.

For example: Suppose your surgeon repairs a torn anterior cruciate ligament (ACL) and a torn medial meniscus on a Medicare patient. He also performs chondroplasty on the lateral meniscus.

Problem solved: You can report all three surgeries, as follows:

- 29888 (Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction) for the ACL repair.

- 29882-51 (Arthroscopy, knee, surgical; with  meniscus repair [medial OR lateral]; Multiple procedures) for the medial meniscus repair.

- G0289 (Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage [chondroplasty] at the time of  other surgical knee arthroscopy in a different compartment of the same knee) for the lateral chondroplasty. Because the National Correct Coding Initiative (NCCI) does not bundle these codes together, you do not need to append modifier 59 (Distinct procedural service) to any of them.

Tip: If you-d like a quick reminder of where the knee structures lie, review our chart in this issue entilted  "Let This Chart Help You Select Accurate Knee Repair Codes".

Buckle Down on ACI Specifics In 2005, CPT introduced 27412 (Autologous chondrocyte implantation, knee), but some coders are still unfamiliar with this fairly new procedure. Here is a quick lesson on ACI coding.

-Patients are usually referred for autologous chondrocyte transplantation if they remain symptomatic after already having surgery for an articular cartilage problem,- says Kathy Tischner, CPC, CCP, coder at Johns Hopkins Orthopaedics at Good Samaritan Hospital in Baltimore, Md. -Once the patient/surgeon decides this is the best option, an arthroscopic biopsy will be performed- (29870, Arthroscopy, knee, diagnostic, with or without synovial biopsy [separate procedure]).

Note: Some payers prefer HCPCS code S2112 (Arthroscopy, knee, surgical for harvesting of cartilage [chondrocyte cells]) when the surgeon harvests the cells.Ask your insurer which code you should report.

The surgeon performs the arthroscopy with a biopsy to harvest normal cartilage from a low-load-bearing area within the knee, Tischner says. -The chondrocytes are sent to a lab to be isolated from the cartilage matrix then cultured for three to four weeks. Once the viable cells are returned in suspension, they are now ready for surgical implantation.-

The surgeon then performs a knee arthrotomy with any necessary debridement, and harvests a periosteal flap, usually along the medial aspect of the tibial [...]