Wiki knee codes

[Rvoigt]

I am working with my surgeon to pre-auth the best codes for a upcoming knee case. The patient needs right knee ACL reconstruction/revision, anterior lateral ligament reconstruction both with allografts, debridement of arthrofibrosis and hardware removal. The doctor wants to code 29888,20680, 27588 or 27427. I think we can only bill 29888 and 27558. Anyone have some thoughts?
Thanks for your time.

 

[ddmcguire]

Hi,

I am fairly new to this, but if I may ask the diagnosis (es). I believe per coding guidelines you are unable to bill both 29888 with 27427.
I was not sure if any of these procedures were open. If done arthroscopically , you may want to use 29867 for allografts, but again I am not sure of the diagnosis (es) I believe that you may be able to bill for 20680, as it is not a separate procedure. The code 27588, does not exist , could this be a typo? I hope that this may help.
ddmcguire

 

[Orthocoderpgu]

This will depend on which insurance company you are billing

First of all, AAOS states to use 29888 for revision of ACL. This includes the removal of the hardware. Most of the time this comes out without any problem. If the physician encounters problems removing the hardware or other issues, you may be able to bill 29888-22. However, my experience has been that removing the hardware from the previous ACL repair is usually not an issue.

CMS bundles 29888 & 27427. However, AAOS does not. So you will have to see which insurance you are billing to see if your allowed to bill 27427 or not.

I've never seen athrofibrosis with ACL revision, I would not bill for that unless it's extensive work. I doubt that insurance companies are going to look at this an enough extra work to warrant payment.

The frustrating thing is that as coders we have to follow coding guidelines (CMS, AAOS, CPT) but insurance companies get to follow the "Golden Rule". They have the gold (making payment) so they get to make up their own rules and their rules do not have to make any sense.