Wiki Ganglion Excison

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adunlap23

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The doctor has scheduled a surgery to remove a ganglion from the anterior/distal aspect of the tibial tunnel. Surgery schedulers have asked me to help them find a code to get authorized for the upcoming surgery.

CPT code 27347 is for excision of lesion of meniscus or capsule (eg. cyst, ganglion). Would this code fit the procedure or should I go unlisted?
I gues the better question is, when the CPT code description says "capsule", is it talking about removing the ganglion from the capsule itself, or from anywhere within the capsule?
 
Are they doing it via scope? If so, that code is not it. I am also not sure I would use 27347 if it was open if it's a cyst following ACL reconstruction in the tunnel. 27347 is capsule or meniscus and that's not really what that is. I guess it depends on what exactly they state in the documentation of where it's eminating from. Are they doing anything else in there at the same time?
 
amyjph said:
Are they doing it via scope? If so, that code is not it. I am also not sure I would use 27347 if it was open if it's a cyst following ACL reconstruction in the tunnel. 27347 is capsule or meniscus and that's not really what that is. I guess it depends on what exactly they state in the documentation of where it's eminating from. Are they doing anything else in there at the same time?
Click to expand...
They are planning on an open procedure. You are correct, is is a cyst following an ACL reconstruction. They are also planning on a possible bone grafting of the tibial tunnel. Are you thinking the ganglion excision would be included?
In the MRI report, it is stated that the ganglion is "within the subcutaneous space immediately anterior to the distal aspect of the tibial bone tunnels". The office note states that is at the pes anserine bursa.
 
Okay, it sounds like there's more going on here. They wouldn't usually bone graft unless this is a re-tear of an prior repaired ACL. So, sounds like the patient had an ACL repair, it's retorn, and now they are going in and cleaning out the tunnels, hardware, & bone graft. Then, they wait for the bone graft to heal and go back in for stage two revision ACL reconstruction. Is that what happened? If that's the case some of that "clean out" and "clean up" may be included in the grafting and hardware removal if there is a screw they take out or other "stuff" like 20680, etc.

If it's the pes it might even end up being 27334. You probably want to auth that & 27347 just in case once they get in there. Synovectomy usually bundles with other procedures in the same location.
 
amyjph said:
Okay, it sounds like there's more going on here. They wouldn't usually bone graft unless this is a re-tear of an prior repaired ACL. So, sounds like the patient had an ACL repair, it's retorn, and now they are going in and cleaning out the tunnels, hardware, & bone graft. Then, they wait for the bone graft to heal and go back in for stage two revision ACL reconstruction. Is that what happened? If that's the case some of that "clean out" and "clean up" may be included in the grafting and hardware removal if there is a screw they take out or other "stuff" like 20680, etc.

If it's the pes it might even end up being 27334. You probably want to auth that & 27347 just in case once they get in there. Synovectomy usually bundles with other procedures in the same location.
Click to expand...
I believe they initially suspected a tear of the ACL graft, but MRI confirmed the ACL was intact/no tear. I agree that there has to be a reason for the bone grafting, but the doctor did not indicate the purpose of the possible grafting. He was very vague in his description of planned surgery.
I will keep looking into it. Thank you for your help!
 
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