Orthopedic Coding Alert

Knowing the theories behind which code matches to which procedure is your key to coding success, but it won't do you any good unless you know how to apply those codes to the reports that cross your desk.

This excerpt from a real report merits one of the following codes:

- 27415 -- Osteochondral allograft, knee, open

- 27416 -- Osteochondral autograft(s), knee, open (e.g., mosaicplasty) (includes harvesting of autograft[s])

- 29866 -- Arthroscopy, knee, surgical; osteochondral autograft(s) (e.g., mosaicplasty) (includes harvesting of the autograft[s])

- 29867 -- Arthroscopy, knee, surgical; osteochondral allograft (e.g., mosaicplasty).

Read the note, make your decision, and then check your answer below.

Analyze the Op Note Learn the Appropriate Code Here

The OATS (osteoarticular transfer system) procedure this op note describes merits new code 27416.

Here's why: The surgeon documents harvesting the graft from the patient, so this is an autograft, not an allograft. That limits your choices to 27416 and 29866.

And although the surgeon does perform part of the procedure arthroscopically, he also notes that he extended the portal "to be a mini arthrotomy and the defect was directly visualized," which is an open procedure.

Tip: You would not report an open and arthroscopic code for the same procedure, says Susan Vogelberger, CPC, CPC-H, CMBS, CCP, president of Healthcare Consulting and Coding Education in Boardman, Ohio.

Payers typically won't allow you to report both the open and arthroscopic elements, so you should only report the open code, which has a higher reimbursement rate.