# Subchondroplasty (bone marrow lesion injections)



## joanne71178 (Mar 19, 2013)

Has anyone ever coded the Subchondroplasty (bone marrow lesion injection)? 

The arthroscope was removed and the subchondroplasty instruments were used wit localization using the navigation system.  A 3.2mm needle with three lateral holes was placed into the tibia approximately 1.6 cm below the articular surface through the predeterminded B3 hole on templating.  Laterally the femoral guide was used to insert a second needle at the line of the posterior femoral cortex within the knee in full extension.  A total of 5 ml of calcium phosphate with methylcellulose carrier was injected and noted to fill the defects in both the femoral and tibial sides of the joint.  After five minutes, the needles were withdrawn and the arthroscope was used to verify there was no extravasation inside the joint.  

The portals were closed with 4-0 nylon.  0.25% Marcaine with epinephrine was injected and the patient was returned to recovery.


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## BRENDASF63 (Mar 19, 2013)

Look at code 27509 percutaneous subchondroplasty.


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## nyyankees (Mar 19, 2013)

joanne71178 said:


> Has anyone ever coded the Subchondroplasty (bone marrow lesion injection)?
> 
> The arthroscope was removed and the subchondroplasty instruments were used wit localization using the navigation system.  A 3.2mm needle with three lateral holes was placed into the tibia approximately 1.6 cm below the articular surface through the predeterminded B3 hole on templating.  Laterally the femoral guide was used to insert a second needle at the line of the posterior femoral cortex within the knee in full extension.  A total of 5 ml of calcium phosphate with methylcellulose carrier was injected and noted to fill the defects in both the femoral and tibial sides of the joint.  After five minutes, the needles were withdrawn and the arthroscope was used to verify there was no extravasation inside the joint.
> 
> The portals were closed with 4-0 nylon.  0.25% Marcaine with epinephrine was injected and the patient was returned to recovery.



It's unlisted and most carriers are not covering it.


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## BCrandall (Mar 20, 2013)

I agree it's unlisted. I'm doing my first one now and I don't see where a fracture is mentioned that would correspond with using 27509. I'm going with 27599 and we'll see if it gets denied!


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## joanne71178 (Mar 21, 2013)

I was advised to code 27415-52 and use 733.90.  

Any thoughts?


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## joanne71178 (Mar 29, 2013)

Has anyone else had any experience w/coding a Subchondroplasty?


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## christinnagle (Apr 11, 2013)

*Subchondroplasty*

I spoke with the company coding/billing support dept and she states that the percutaneous or arthroscopy codes are correct. I don't feel confident in their answer. Any other suggestions are appreciated. My ortho docs do alot of these. I've been billing these as unlisted depending on documentation.


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## nyyankees (Apr 11, 2013)

christinnagle said:


> I spoke with the company coding/billing support dept and she states that the percutaneous or arthroscopy codes are correct. I don't feel confident in their answer. Any other suggestions are appreciated. My ortho docs do alot of these. I've been billing these as unlisted depending on documentation.



be careful when you get coding info from a manufacturing co. They should be able to support their findings with either CPT/AMA, CMS or AAOS documentation.


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