Wiki Knee arthroscopy w/removal of hardware & bone graft of tunnels CPT?

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What would you code:

Knee arthroscopy with the removal of hardware and bone grafts of tunnels. This procedure is in prep for the ACL and does not include the ACL.

We are baffled.
:confused:

Thank you so much!!!
 
Thank you so much for the reply, but that code is just for the removal of hardware, and according to the doctor, the major part of the surgery is the bone grafts of tunnels.

If anyone has any other ideas, we would really appreciate it.
 
Acl

i had a dr do a 29881 and while he was doing that he did prep-work for a ACL revision and I too was stumped.

What I did was bill the 29881 and then a few weeks later billed out the 29888 revision w/o the 22 modifier. So I agree with ILuvRock's assesment.

Just my thoughts but I couldn't find a CPT code that tunneling.:eek:
 
We had a similar case. Our patient had a previous ACL reconstruction with quadriceps autograft. Then experienced a re-tear of the ACL and medial meniscus tear. The repair was performed in 2 stages. For Stage 1, since there is no code for a REVISION arthroscopic ACL reconstruction or for the tunneling bone graft, we reported unlisted code 29999 with comp code 11044-22 for debridement of the graft plus placement of a new allograft. He removed other hardware, so we coded 20680.

The provider wanted to use a bone harvesting code (20900, 20902). However, these codes are only to be reported when the graft is harvested from a “separate” site through a separate skin or separate fascial incision, and “when the graft is not already listed as part of the basic procedure,” according to notes at the beginning of the Musculoskeletal System Section of the CPT Manual. Since an allograft is being used in this case, neither of these codes would be appropriate.
 
BLumetta said:
We had a similar case. Our patient had a previous ACL reconstruction with quadriceps autograft. Then experienced a re-tear of the ACL and medial meniscus tear. The repair was performed in 2 stages. For Stage 1, since there is no code for a REVISION arthroscopic ACL reconstruction or for the tunneling bone graft, we reported unlisted code 29999 with comp code 11044-22 for debridement of the graft plus placement of a new allograft. He removed other hardware, so we coded 20680.

The provider wanted to use a bone harvesting code (20900, 20902). However, these codes are only to be reported when the graft is harvested from a “separate” site through a separate skin or separate fascial incision, and “when the graft is not already listed as part of the basic procedure,” according to notes at the beginning of the Musculoskeletal System Section of the CPT Manual. Since an allograft is being used in this case, neither of these codes would be appropriate.
Click to expand...
What did ya'll use for the second stage? Because it feels like we are doing part of the 29888 the first time.
 
In a case where my surgeon did a diagnostic scope and debrided the old ACL graft and suture material, placed allograft dowels, then opened the previous incision to remove the biocomposite screw, I billed:
20680 Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)
28750-51 Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)
Can't bill anything for allograft placement.

CPT Assistant November 2016 page 9
Frequently Asked Questions:Surgery: Musculoskeletal System
Question: Our surgeon performed a revision arthroscopic anterior cruciate ligament reconstruction. The patient previously had an arthroscopic anterior cruciate ligament reconstruction performed by another surgeon and sustained another injury that ruptured the graft. As part of the revision procedure, our surgeon removed the graft and fixation screws that were implanted by the other surgeon. In addition to reporting code 29888, Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction, for the revision reconstruction, is it appropriate to report code 20680, Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate), for removal of the screws?

Answer: Yes, code 20680 may be separately reported for removal of the screws in addition to code 29888.

Ortho Pink Sheet 2019-08
redo of an ACL reconstruction
depends on number of stages
Question: Any thoughts about how to code revision of
an arthroscopic ACL reconstruction? Should we still use
29888, maybe with a modifier? This is for precertification,
so there is no operative note thus far.

Answer: There is no code for revision of an ACL
reconstruction. Coding will depend on whether the procedure
is done all at once or in stages. If it’s a single stage
revision, report 29888 (Arthroscopically aided anterior
cruciate ligament repair/augmentation or reconstruction)
with modifier 22 (Increased procedural services). The
AMA instructs that you may also be able to report 20680
(Removal of implant; deep [eg, buried wire, pin, screw,
metal band, nail, rod or plate]) if the surgeon removed a
previously placed screw through an open incision.
If the surgeon does a staged revision, - the first procedure
is normally the removal of the previous screws filling the
holes with bone grafting, which could fall under 20680 if the
surgeon uses an open incision. The physician then usually
performs an arthroscopy to clean up the previous graft
rupture, so you can list the appropriate scope code for that.
When they bring the patient back to do the actual revision,
report 29888-22, based on guidance from American Academy
of Orthopaedic Surgeons (AAOS Bulletin, April 2005).
 
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