Orthopedic Coding Alert

Question: Another orthopedic surgeon performed a faulty ACL reconstruction on a patient, and our surgeon had to go in and perform an enormously complex revision of the reconstruction to repair the problem. How should we report our revision? Nebraska Subscriber Answer: Sometimes patients can walk around for years with a flawed ACL reconstruction, only to reinjure themselves playing sports or twisting their knees. Unfortunately, only one code describes these taxing and time-consuming operations: 29888 (Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction). Problem: ACL revision can be more complex than what 29888 describes. For example, your surgeon may have to remove the hardware that the other surgeon left in place, take out a previously placed tendon graft, and revise tibial and/or femoral tunnels. Also, scar tissue may make surgical dissection more complicated.Convey all the extra hard work by adding modifier 22 (Increased procedural services) to 29888. 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 for: Some payers may prefer 29999 (Unlisted procedure, arthroscopy) for this procedure.