Wiki 2 stage ACL revision

[scooter1]

In the first stage he did open removal of hardware. The he went arthroscopic and did a lateral meniscectomy, a notchplasty,
and then used a curette, shavers and reamers to clean out the previous femoral tunnel. He then "widened" the anteromedial portal and packed bone graft into the femoral tunnel defect. It was filled in its entirety. The defect on the tibial side was not large enough to need to be bone grafted.
copiously irrigated and evacuated, all instruments were withdrawn.
I am thinking 20680 for the open removal of the hardware.
and 29881 for the arthroscopic lateral meniscectomy.
Other than that, I am at a loss on the rest of the procedure. Dr is stating 27356 for the cleaning out of the tunnel and bone grafting, but doesn't sound right to me. I really need suggestions here. I actually have three of these surgeries that have come across my desk. I have heard some people say if scope use 29867 for grafting the tunnels, or open use 27415. What do you think ?
PLEASE HELP ?

 

[meghanhannus]

In the first stage he did open removal of hardware. The he went arthroscopic and did a lateral meniscectomy, a notchplasty,
and then used a curette, shavers and reamers to clean out the previous femoral tunnel. He then "widened" the anteromedial portal and packed bone graft into the femoral tunnel defect. It was filled in its entirety. The defect on the tibial side was not large enough to need to be bone grafted.
copiously irrigated and evacuated, all instruments were withdrawn.
I am thinking 20680 for the open removal of the hardware.
and 29881 for the arthroscopic lateral meniscectomy.
Other than that, I am at a loss on the rest of the procedure. Dr is stating 27356 for the cleaning out of the tunnel and bone grafting, but doesn't sound right to me. I really need suggestions here. I actually have three of these surgeries that have come across my desk. I have heard some people say if scope use 29867 for grafting the tunnels, or open use 27415. What do you think ?
PLEASE HELP ?

Hello scooter1,

I am not sure that CPT 29867 or CPT 27415 would be the correct codes as it is for placement of an osteochondral allograft and I don't see mention of that with in the documentation you have provided. The MD's code is for excision of a cyst or tumor and I don't see that mentioned either. If the bone graft was placed where the hardware was removed I believe that is inclusive to CPT 20680. If not than since a dx isn't listed I am not 100% sure on the code but was thinking maybe you should look at CPT 27360??? It seems as if part of the procedure was through the scope and the other part open. Here is the description of CPT 27360: The physician performs a partial excision of the femur to remove infected bone. An incision is made over the infected part of the bone and the underlying soft tissues are divided to expose it. The periosteum is reflected and the infected portion of bone is removed and irrigated. The excavation of bone may excise a crater-like piece, leave a small saucer-like shelf depression in the bone, or may remove a portion of the shaft (diaphysis) of a long bone. If a significant portion of bone is removed, the physician may use bone graft material to fill the cavity left in the bone. The periosteum is closed over the bone, the soft tissues are sutured closed, and a soft dressing is applied.

 

[Orthocoderpgu]

I agree with Megan

There is no code for cleaning out the tunnels and packing them with bone graft material. For this situation you would be billing 20680 & 29881 only.

Her explanation was excellent.