# Bone Grafting tibial and femoral tunnels knee, failed ACL



## cwilson3333 (Sep 8, 2019)

Procedures Performed
Arthroscopy
Debridement ACL Graft
Removal Tibial Button
Bone Grafting Tibial and Femoral Tunnels knee

Portion of op note reads as follows:
ACL was completely absent in mid aspect. Remaining soft tissue was debrided along tibia. Tibial tunnel was found to be anterior, perhaps more inferior than would be in an anatomic ACL insertion.  Femoral Tunnel was inspected and found to be slightly superior and ideal.  Decision made to bone graft the tunnels rather than doing a revision ACL reconstruction.  Incision made over tibia through previous incision to locate the tibial button.  Dissection continued with use of knife to expose button. Sutures were cut and button removed...…………..femoral site addressed by hyperflexing knee.  Notchplasty performed for visualization. ……….9 mm dilator in medial portal and into femoral tunnel. Guideline placed. Reamed to 9 mm  and 9 mmx15mm graft placed into femoral tunnel.
Thinking to code 29888-52
Would like input from other "seasoned coders"
Thanks


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## Orthocoderpgu (Sep 9, 2019)

This is the great debate in ortho coding. Your going to need to get very familiar with 2017 CMS NCCI Surgical Policy Manual. There is no code for bone grafting. In cases like these your going to need to bill out "what you can" which in this case would be 20680. I would look at billing 29877 for the debridement of the soft tissue. It does not hit an edit, but be prepared for insurance to deny it. To me it really is a separate issue especially since the debridement was performed first, not as a clean up after the hardware was removed.


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