Orthopedic Coding Alert

Question: How do I code the following situation?

Postoperative diagnosis: 1. Small tear of the posterior horn of the menial meniscus. 2. Stretched, loose anterior cruciated ligament.

Operation: 1. Partial medial meniscectomy. 2. Thermal shrinkage of the anterior cruciate ligament.

Do I use a 29909 for the thermal shrinkage of the anterior cruciate ligament, and do I need a modifier for separate procedure from the meniscectomy?

Tammy Williams
Martinsburg, WV

Answer: In the CPT manual under the endoscopy/arthroscopy section, there is no specific code for a thermal shrinkage of the anterior cruciate ligament, says Catherine Brink, CMM, CPC, president of Healthcare Resource Management Inc., a practice management and reimbursement consulting firm based in Spring Lake, N.J. When there is no specific code to describe accurately the service or procedure performed, the unlisted procedure code at the end of the anatomical section or type of service performed should be used. Consequently, the correct code for the thermal shrinkage of the anterior cruciate ligament is 29909 (unlisted procedure, arthroscopy). This code should be billed with modifier -59 (distinct procedural service) to indicate it was a distinct and independent procedure from the debridement.

Some carriers may require a modifier -51 (multiple procedures) be attached to the 29909, but you should check with the carrier before appending this modifier.

A copy of the operative report should be sent with the claim to ensure appropriate reimbursement. If your practice will be doing a number of these procedures, check with your major payers and speak to a reimbursement manager to find out how this procedure should be submitted. This will ensure you receive accurate and timely payment and do not have to handle appeals.