Orthopedic Coding Alert

Question: What code would I use for a knee arthroscopy with OATS procedure? In the op note, the orthopedist states that he transplanted osteochondral auto- and allograft tissue to the medial femoral condyle. We used 29866, but the carrier denied payment for the procedure, stating that it was experimental. Georgia Subscriber

Answer: During an osteoarticular transfer system procedure, your orthopedist uses the arthroscope to treat focal cartilage defects by moving small pieces of undamaged cartilage within the joint to a damaged area of cartilage or implanting allograft plugs. He may use the patient's own cartilage (autograft) or that from a cadaver (allograft).

When the surgeon uses an autograft, you should report the procedure with 29866 (Arthroscopy, knee, surgical; osteochondral autograft[s] [e.g., mosaicplasty] [includes harvesting of the autograft]). If he uses an allograft, however, you should rely on 29867 (... osteochondral allograft [e.g., mosaicplasty]). Consequently, you were correct when you reported your physician's work with 29866. Unfortunately, some carriers still consider this procedure experimental. Your best bet is to  recertify the surgery and verify the patient's benefits before scheduling it so the patient knows whether the payer will cover the procedure.