Orthopedic Coding Alert

ACL, PCL repairs are different sides of the same coin.

When most people think of knee injuries, the anterior cruciate ligament (ACL) is often at the top of that list. An ACL tear is a debilitating injury that acutely affects patients for years after it's fixed.

There's another, similar, injury that a patient might also suffer: a posterior cruciate ligament (PCL) tear. This is a different injury than an ACL tear; more importantly, you have to be ready to choose a different code for a PCL tear repair.

Check out this quick advice on the ins and outs of PCL repair.

Remember, Posterior Is 'Back'

In order to choose 29889 (Arthroscopically aided posterior cruciate ligament repair/augmentation or reconstruction), you'll need to use the same coding skills you use to sniff out an ACL repair - with a slight twist.

"Anterior is in front of the knee, posterior is behind the knee; so as a coder knowledge of knee anatomy is helpful," explains Denise Paige, CPC, COSC, orthopedic surgery coder at PIH Health in Whittier, California. "Taking note of the findings and subsequent repairs in different areas should be clear in the op note.

"Hopefully, the surgeon is good at listing terms that help identify the ligaments he's working on. In an ideal situation he'll say he's working on the ACL and/or the PCL," Paige continues.

Best bet: Make sure your knee anatomy knowledge is on point, and you should have no problem discerning between ACL and PCL tears. If there is any doubt as to the injured ligament, check with the performing provider before coding.

Report ACL/PCL Combo, when Appropriate

If your orthopedist performs arthroscopic fixes on the ACL and PCL in the same session, you can report the procedures together - but you might need a modifier other than 59 (Distinct procedural service).

According to Lynn M. Anderanin, CPC, CPMA, CPPM, CPC-I, COSC, senior director of coding education at Healthcare Information Services in Park Ridge, Illinois, there is no Correct Coding Initiative (CCI) edit between 29888 and 29889 (Arthroscopically aided posterior cruciate ligament repair/augmentation or reconstruction).

So, you should be able to report 29888 and 29889 together without modifier 59. The ACL and PCL are different ligaments, so each repair is considered separate, Anderanin says.

Alert: When you're reporting 29888 and 29889 together, "some carriers require use of the 51 modifier [Multiple procedures] on the lesser procedure to indicate a multiple procedure," says Paige. In this case, 29888 is the lower-paying procedure, so you'd append modifier 51 to the ACL repair code, if necessary.