Orthopedic Coding Alert

Question: One of our physicians performed a distal tubercle transfer medially (Elmslie-Trillat procedure) and an open medial patellofemoral ligament imbrication. For the Elmslie-Trillat, 27420 (reconstruction of dislocating patella; [e.g., Hauser type procedure]) seems appropriate, and for the open medial patellofemoral ligament imbrication 27422 seems appropriate. But 27420 is bundled with 27422, so we end up only using 27422. Is this correct coding?

Ohio Subscriber

Answer: With so many acronyms used to describe reconstruction procedures for recurrent patellar dislocations, it is easy to get confused. An Elmslie-Trillat procedure includes the following components: lateral retinacular release, medial capsular reefing (which your surgeons describe as medial patellofemoral ligament imbrication) and medial displacement of the infrapatellar tendon insertion. Appropriate coding selection for this procedure is 27422 (reconstruction of dislocating patella; with extensor realignment and/or muscle advancement or release [e.g., Campbell, Goldwaite type procedure]). No additional code would be reported for the lateral retinacular release because this is a component part of 27422 according to the American Academy of Orthopaedic Surgeons Complete Global Service Data for Orthopaedic Surgery.