Orthopedic Coding Alert

Question: My orthopedist did an ACL repair on a patient several years ago. The graft failed, and now he wants to schedule the patient for a revision of the ACL. What code should I use for this?

Arizona Subscriber

Answer: You wont find a specific code for a revision or redo of arthroscopic ACL reconstruction. You have 29888 (Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction), but a revision often can be more complex than the work 29888 describes. For example, your surgeon may have to remove the hardware that he left in place during the first surgery, take out a previously placed tendon graft, and revise tibial and/or femoral tunnels. Also, scar tissue may make surgical dissection more complicated.

You can report 29888-22 (Increased procedural services) to convey all the extra hard work. Submit supporting documentation along with the claim, explaining why you appended the modifier (including why the revision was more complex and how the revision differed from the initial repair/reconstruction). Also, indicate the extra time the revision surgery involved compared to the standard ACL reconstruction.

Watch out: CPT guidelines prohibit you from reporting 29888 along with a hardware removal code (such as 20680, Removal of implant; deep [e.g., buried wire, pin, screw, metal band, nail, rod or plate]) in cases where the orthopedist has to remove metal hardware to proceed with another procedure.