# ACL repair with hamstring autograft



## Nabelle

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A provider performed a 29888 w/29881. Documentation is appropriate for the services reported. He also performed a hamstring autograft and didn't report it. I found an Orthopedic Coding Alert that states the hamstring autograft is inclusive to 29888. Can anyone tell me if and why this is correct


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## BCrandall

If it's an autograft, I use 20924. I don't code an allograft for ACL repair.


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## nyyankees

I thought for ACL repair you could only report the graft if it was harvested from the other leg. Am I wrong?


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## BCrandall

I was taught that if it's a separate incision, you can use 20924. CPT says "from a distance" so I interpret the lower excision as a distance!


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## mbort

http://www2.aaos.org/aaos/archives/bulletin/apr05/code.asp

ACL reconstruction

The CPT code for an arthroscopic ACL reconstruction is 29888, “Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction.” According to the AAOS Global Service Data Book (GSD), this code covers: minor synovial resection for visualization; notchoplasty; ACL stump removal; partial synovectomy and fat pad resection; intra-articular ligament reconstruction; harvesting and insertion of fascial, tendon or bone graft; diagnostic knee arthroscopy; internal fixation for graft; arthroscopic lysis of adhesions; manipulation of the knee, and additional or enlarging portals.

Excluded from an arthroscopic ACL reconstruction are: meniscectomy; meniscus repair; extra-articular augmentation, exclusive of screw tenodesis of the illiotibial band; arthroscopic chondroplasty, separate compartment; arthroscopic abrasionplasty; and arthroscopic removal of loose bodies.

Some orthopaedic surgeons have begun using thermal treatments to “tighten” a stretched ACL or to treat ACL laxity. CPT warns that it is incorrect to select a code that “merely approximates” the service being rendered and specifies that the anatomically specific unlisted code should be used. This means that code 29888 should not be used for thermal ACL procedures. The unlisted code 29999 should be used instead. 

Because there is also no code for a revision (re-do) arthroscopic ACL reconstruction, this procedure could be reported with either code 29999 (unlisted) or code 29888-22. An open revision ACL could also be reported with the unlisted code (29999) or by appending modifier –22 to the original ACL code.

*Harvesting and inserting the graft is included in code 29888, regardless of whether the graft is a patellar tendon or a hamstring tendon. If, however, the tendon is obtained from a distant site, such as the opposite leg, you may report the harvesting separately, using the most appropriate graft harvesting code (such as 2902X).

The rules for using the bone harvesting codes (20900, 20902) and the codes for harvesting other grafts are often misunderstood. 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.*
Some surgeons are now harvesting bone from the proximal tibia (e.g., from the bone tunnel) and grafting it to the patellar bone defect. This is considered a local bone graft, which is included in the base procedure, and should not be reported. Reporting this as a harvest and transplant would be considered unbundling.


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## Nabelle

Thank you very much to everyone who replied.  I appreciate the guidance and knowledge you have shared.


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## MsLady

This information is very helpful.....THANKS!!


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