Correct Coding for Osteochondral Transplant
Published on Mon Feb 01, 1999
In the last several years, a number of expensive new treatments for injury or degeneration of the cartilage of the knee have appeared. One of the more affordable treatments is the autogenous osteochondral transplant (also known as an OATS or MosaicPlasty). We have been performing this procedure for about a year-and-a-half, says Shari Benton, coding and reimbursement specialist with the Cleveland Clinic Foundation, Cleveland, OH. According to Benton, the procedure continues to grow in popularity primarily because it is less expensive, can be done in one procedure and can be done arthroscopically.
Understanding Knee Cartilage Repair
According to the National Center for Health Statistics, almost 5 million people visit orthopedic surgeons offices each year because of knee problems. More than 3 million of these visits are injury-related; the remaining are due to arthritis and other disorders. Another 1.4 million people go to a hospital emergency room for knee problems. Many of these problems will be related to injury or degeneration of the knees cartilage, and it is important that the orthopedic coder understand the varieties of new treatments being used.
The knee is an active joint with a large area of articulating contact. This area of contact is protected by a smooth cartilage surface that can be disrupted or lost due to injury or degeneration, causing pain and sometimes loss of movement. Historically, orthopedic surgeons have treated the problem by shaving or scraping the cartilage until it bleeds (29877). This procedure can stimulate the growth of a thick layer of scar tissue and restores a smooth articulating surface. The procedure isnt always successful, so in recent years new methods have been developed that actually transplant good cartilage into the problem area.
One of these procedures involves taking cartilage tissue from the patients knee and then sending it to a lab where it is grown under special conditions for a couple of weeks and then returned to the patients knee. However, the procedure has been impractical for many because it is often not covered by private carriers, involves two surgeries and could cost as much as $60,000.
The autogenous osteochondral transplant (which has been compared to hair transplantation) is more affordable and involves a single surgical procedure. One or several cylindrical osteocartilaginous grafts are taken from peripheral and non-weight-bearing areas of the knee (donor site) and are transferred to the prepared damaged area (recipient site) usually under arthroscopic visualization, which requires extensive arthroscopic experience and skills by the performing surgeon. There are several different techniques used to perform the procedure with each using precise instrumentation that bears the different manufacturers name and can lead to coder confusion about what was performed. Most commonly done osteocartilaginous transfers utilize one of the following [...]
