Wiki Staged ACL Revision

cwilson3333

Expert
Messages
289
Location
Hamilton, VA
Best answers
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Procedure performed
Medal meniscal Repair [29882]

Debridement ACL Graft and Allograft bone grafting and debridement of femoral and tibial tunnels CPT ???

Am unsure of how to code for this debridement and bone grafting for the ACL staged revision
.....ACL graft was debrided with use of shaver. Femoral tunnel addressed first. An 8 spacer was placed in femoral tunnel. Guide pin drilled into bone. Femoral tunnel was drilled up to 10.5 reamer. 10 mm graft placed into femoral tunnel.
Guide then placed into cut tibial tunnel. Guide pin placed. Tibial side reamed up to 9 mm reamer. 9 mm allograft placed in tibial tunnel.....

Am unsure how to code the Debridement and Bone Grafting.

Asking for help,
CW
 
Hi you mentioned this was a staged procedure - any chance you can post the entire operative report without patient info? I wanted to see the history here to better define the stages of reconstruction and see the indication for the procedure being performed in this stage. That would help me to provide some better guidance.

Kim
 
Kim,
Patient had a medial meniscus repair [29882] this surgery also, so am only sending the ACL documentation in operative note.
Procedure for ACL was Debridement ACL Graft. Allograft bone grafting femoral an Tibial Tunnels, with Debridement of Tunnels

The previous ACL graft was debrided with the use of a shaver. The femoral tunnel was easily visualized with flexing the knee beyond 90 degrees. The femoral tunnel was a little high. The tibial tunnel looked to be in a good position. The femoral tunnel was addressed first. An 8 spacer was placed in femoral tunnel. A guide pin was then drilled in the bone. The femoral tunnel was drilled up to 10.5 mm reamer. A 10 mm graft was then placed in the femoral tunnel.

ACL guide was used on the tibial side. The guide was placed in the medial portal. It was placed into the middle of the cut tibial tunnel. The guide pin was placed. The tibial side was then reamed up to a 9 mm reamer. This demonstrated circumferential exposed bone. A 9 mm allograft was then placed into the tibial tunnel to be flushed with the articular surface. The knee was drained. an instruments' were removed. Skin closed with 3-0 and 4-0 Monocryl subcuticular interrupted suture. Derma bond placed on tibial incision. Benzoin and SteriStrips placed. Tourniquet released. Sterile dressing placed followed by Ace bandage. Patient placed in knee immobilizer. The was extubated and transferred in stable condition to recovery room.
 
Hello,
How did you end up coding the Staged ACL? I am currently in that same situation with a revision and insertion of bone dowels. The struggle is real, I've been researching for hours!
 
This is an old thread. But, if you search the forums there is a lot of info on this. Stage one is (usually) removal of the prior screws, graft, etc. and grafting of either both tunnels or one depending. Then, they wait an alotted amount of time for the graft to heal and go back in to do the ACL over.
Use the search in the forum.
 
I think there might be CPT Assistants about it. The first stage is usually 20680, depending on the case. Sometimes they need mensicus work and/or other things at the same time. Also depends on where they get the graft, if it is allo vs auto, etc. etc.
When they go back to do the stage 2 it is 29888 sometimes with a 22 depending on the documentation.
It really dpends on the op note. I have seen cases where it is more involved and they actually do more bony work in an open fashion in stage one, then you may be looking at different codes like 27637, 27638, 27356 type. There isn't a 100% answer for it.
 
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