Orthopedic Coding Alert

Don't be too hasty when reporting additional procedures your orthopedist completes during ACL surgery. The American Academy of Orthopedic Surgeons (AAOS) Global Service Data (GSD) book considers many intraoperative services to be part of the global ACL package. Here are some companion services you'll see most often but can't report separately, with example codes in parentheses:

• minor synovial resection for visualization (29875)

• partial synovectomy and fat pad resection (29875, 29976)

• intra-articular ligament reconstruction (27428, 27558)

• diagnostic knee arthroscopy (29870)

• arthroscopic lysis of adhesions (29884)

• knee manipulation (27570).

Harvest hint: Payers include graft harvest and insertion in 29888, whether the graft is a patellar tendon or a hamstring tendon. "The use of an allograft and the autograft harvest from the same body area are included in the reimbursement calculations for 29888," says Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, coding and compliance supervisor for Proliance Orthopedics and Sports Medicine in Belleview, Wash.

Exception: But if the surgeon obtains the graft from the opposite leg or other distant site, you may report the harvesting with the appropriate code, such as 20924 (Tendon graft, from a distance [e.g., palmaris, toe extensor, plantaris]).

Once you clear the global package hurdle, don't trip over your surgeon's terminology. Although a graft usually indicates a reconstruction, there are times your surgeon might use a graft to complete a primary repair.

Some ACL tears are new injuries, but others might be "acute on chronic," Stumpf says. "There may have been repetitive injuries over time with a final injury that ruptures the remaining fibers."

In these cases, portions of the ligament might be shortened or scarred down, which means the surgeon is unable to reattach the ligament to the original insertion. Other times, the ligamentous fibers might be extremely frayed or traumatized so the surgeon doesn't have enough viable tissue to effect a strong repair.