Question Bone grafting of the femur and tibial tunnels CPT code

jdibble

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I need help with coding the following procedure as soon as possible:

Preoperative Diagnosis: INSTABILITY RIGHT KNEE

Postoperative Diagnosis: INSTABILITY RIGHT KNEE

Procedure Performed: Bone grafting of the femur and tibial tunnels as a stage procedure for future ACL reconstruction

Indications: Patient who has knee instability after having had a 2nd ACL revision. Patient was found be appropriate for removal of the previous allograft ACL and bone grafting of the femoral and tibial tunnels as a stage procedure for future ACL reconstruction. Risks benefits this procedure were discussed with the patient and their family preoperatively and informed consent was signed prior to the operation today.

Findings: Insufficient ACL with a partial tear of the anterior fibers

Technique/Description of Procedure: The patient was taken operating room on 06/04/2019. The right lower extremity was prepped and draped in usual sterile manner after adequate anesthesia had been obtained. The the incision was made 1st over the tibial tunnel to remove the post and washer screw along with the interference screw. The screws were removed and the remaining graft was removed from the tibial tunnel using a rongeur and curette then the scope was placed into the knee joint through an anterior lateral portal. The graft was removed from the femoral tunnel using combination of shaver, Reamer, curette and rasp. After the tunnels were cleared of soft tissue back to bleeding bony walls then the bone graft was opened and thawed and prepared on the back table. A plastic syringe was used as a cannula to introduce the bone graft into the femoral tunnel using a dry socket method. The bone graft was packed in using a curette and bone tamp. Then attention was turned to the tibia and the tibia bone graft was inserted and packed in. With satisfactory fill of the tunnels with bone graft then the procedure was concluded. The incision sites were closed with 2-0 Vicryl suture and 3-0 nylon suture. Sterile dressings were applied and the patient was placed into a knee immobilizer and awakened from anesthesia and taken to the recovery room in stable condition.

I am not sure what codes this should be. It was billed to Medicaid with 27415,RT, 27599, 206380,59,RT, 27331,RT,59. These were all denied as not substantiated by the documentation. If I can get some information on what code or codes would be correct it would be greatly appreciated!!

Thanks, Jodi
 
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