Orthopedic Coding Alert

Case Description

The patient is a 50-year-old female with symptomatic osteochondral defect of the medial femoral condyle. The orthopedist recommends surgery to restore function and reduce pain. Traditional surgery to repair such damaged articular cartilage involves scraping the area to induce bleeding, which then fills in the damaged area.

But a new procedure called MosaicPlasty, or osteochondral allograft transfer (OATS), takes healthy cartilage plugs from the donor site (peripheral or non-weight-bearing areas of the knee) and transfers them into the prepared damaged area (recipient site). Usually MosaicPlasty is done under arthroscopic guidance, but it can also be done as an open procedure based on surgeon preference and the location and extent of the chondral defect and harvest site.

Operative Report

Three arthroscopy portals were established to include superior medial inflow and medial and lateral working joint line portals. Inspection of the joint revealed 9 x 20 mm medial femoral chondylar full-thickness chondral defect with osteochondral loose bodies located intra-articularly.

Using meniscal graspers, loose bodies of multiple osteochondral fragment, including several large fragments, were removed from the joint without difficulty. The defect having been measured, the rim was cleaned with a currette. The size was defined and the determination was made to proceed with the OATS procedure rather than the Genzyme Carticel biopsy.

An 8 mm size was chosen and a series of two plugs were performed. The vicinity of the sulcus terminale of the lateral femoral condyle was utilized for donors. A series of two plugs were harvested. A donor graft was harvested first; the recipient graft was measured and harvested to match. Sequential implantation of the plug was performed without difficulty. The plugs were noted to restore congruity of the joint surface appropriately.

Having thus completed the osteochondral plug transfer, copious irrigation of the joint was performed and close was performed. It should be noted that two accessory medial portals were utilized to optimize angular approach to the medial femoral condylar region.

Coding Dilemma

With OATS, as in many other orthopedic procedures, technology has outpaced development of CPT codes: None describe this new procedure precisely.

But in trying to find a code that best describes the procedures, orthopedists, who are often misinformed by sales reps, may be upcoding, experts warn.

For example, for a MosaicPlasty with eight plugs, one physician believed he could bill 27442 (arthroplasty, femoral condyles or tibial plateaus, knee) as well as charge eight times for 29885 (arthroscopic OCD drilling with/without internal fixation).

Such logic leads to upcoding, warn our coding experts.

The American Medical Association (AMA) also states chondroplasty of the knee (29877) should not be reported separately because its considered part of the overall procedure. Likewise, it would be inappropriate to bill any [...]