Wiki 29867 or 29879

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kdsampson

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I'm not sure if I should use 29867 or 29879 on this. Also, Dr. did a PRP injection, would that be bundled as well? An article from Becker's ASC says it is, but I can't really find anything else on it other than PRP's are usually considered investigational.

Here's the report-
He was noted to have an approx. 8x1 cm full thickness chondral lesion on the weight-bearing portion of the medial femoral condyle. Utilizing a shaver, the synovium was debrided from around the chondral lesion. A shaver was then used to remove the calcified cartilage from the base of the lesion. Utilizing the Arthrex power pick, a microfracture was performed on the lesion. The area was again shaved. Blood was drawn and spun down and the morselized cartilage was mixed with PRP. This was then injected into the lesion and smoothed down with a freer. Fibrin glue was placed over the top and this was allowed to sit for 5 minutes. Upon completion of this, the remaining PRP was injected into the joint.

Any help is greatly appreciated.

Thanks!

Kimberly
 
I also have a question about this... can anyone answer? The doctor seems to have done both codes 29867 and 29879, the problem is code 29879 does not allow 29867 during the same session, same compartment, which code would you use? Do you have to pick 29879 or 29867?
 
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I have the exact situation, same compartment of knee, I am going to choose 29867, no one has responded to my procedure note. :) My final decision was based on the weight of the RVU which is more for CPT code 29867 I am still learning Ortho.
Melissa Bedford,CCS,CPC
 
Darn I was hoping someone would answer you, I know I should probably pick 29867 too, but that code has other issues such as medical necessity that I don't think the provider met, so wanted to pick 29879 instead.
 
Hope this helps :)

If the surgeon did both I would code both as 29879 is not included within 29867 global package per the GSD guide if it is in separate compartments. If that is not the case I would go with the highest RVU's if it is the reason for the surgery and supports medical necessity. If you can't prove medical necessity, code for what you can prove.:)


Lekisha Bryant, CPC, COSC
 
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29879, the Microfracture, is used to make drill small holes into the bone to encourage healing. 29866/67 are drill holes on defects of the bone and putting in auto/allografts respectively.

In the original poster's report, I believe it's more of a Microfracture procedure. The PRP would be considered inclusive because it's post operative pain relieve.

Agree with lekishabryant that if there's multiple compartments of the knee worked, and documented, you can definitely bill with special modifiers. But looks like all work was done in the Medial Compartment.
 
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