Question "Pie Crust" Release of Medial Collateral Ligament Code, Please?

KStaten

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Hello Everyone! :giggle:

I have come across a procedure that I haven't encountered before and I am perplexed. While performing a total knee arthroplasty (27447) due to OA, the surgeon also performed a "pie crust release on the MCL," whereas the patient had a fixed varus deformity and a flexion contracture, as well.

The closest codes that I can find for the release are as follows:
27425- Lateral retinacular release, open
27427- Ligamentous reconstruction (augmentation), knee; extra-articular :unsure:


While the first is a "release," it doesn't fit the structure; and, though 27427 fits the structure, I'm not sure if the procedure would exactly qualify as "reconstruction." Is this yet another time where I am simply overthinking? I would appreciate your input so that I (hopefully) won't have to use an unlisted code!

NOTE: The other monkey wrench 🔧 to be thrown in would be Could this even be billed with the total knee replacement? Codes 27245 and 27427 both bundle into 27447. Even still, knowing the correct code for future references would be helpful.

Thank You in advance,
Kim
 
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Orthocoderpgu

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Kim, keep in mind that "Smaller" surgical procedures are usually bundled when a more significant procedure is performed in the same area. You don't get much bigger of a procedure than a joint replacement. 27425 is for release of "retinaculum". 27427 is coded when the ligament is replaced. You will know this because the physician will need to drill a hole in the femur and patella and anchor the ligament at both ends. You will not be billing either code with the knee replacement.
 

KStaten

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Thank you, Orthocoderpgu! :) As, always, I appreciate your help! I'm still curious, however, as to what the code would have been if this hadn't been performed with the knee replacement. I am guessing we would have to use the unlisted code, but we would still need a code for comparison. As we've said, the two that I have listed do not match, but seemed somewhat similar. So, I'm wondering if there is a better code out there. :unsure:

Thanks!
Kim
 
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