Orthopedic Coding Alert

" There are several methods by which a physician can achieve anterior cruciate ligament (ACL) revision or reconstruction, but only two codes to describe them. Arthroscopic or open ACL repair, thermal ACL shrinkage, revisions, and ACL repair along with other knee procedures make for coding headaches and reduced reimbursements, but you can avoid both through thorough documentation and correct modifier use. What Is ACL? The ACL is located in the center of the knee, behind the kneecap, and runs from the femur to the tibia. As the major stabilizing ligament of the knee, it prevents buckling and instability.

ACL problems are typically the result of pivoting, twisting, hyperflexion and hyperextension injuries to the knee. Individuals who ski, play football or in-line skate frequently injure themselves in this manner. An ACL injury can be relatively minor, such as a pull or stretch, or severe, where the ligament is partially torn or completely ruptured. Minor ACL injuries can be treated nonoperative-ly with physical therapy and bracing, and incomplete tears can be repaired without the use of graft material, whereas torn ACLs have to be reconstructed with the use of autograft or allograft tissue.

Repair of the ACL involves using sutures to anchor the torn ligament to its original point of attachment on the femur to set it back into its correct anatomic site. Although the procedure can be done by open repair, it is most often accomplished arthroscopically.

An emerging procedure, thermal ACL shrinkage, is used to stretch injuries of the ligament that do not require tendon graft. With arthroscopic guidance, a thermal probe is inserted into the knee, where it heats the damaged ligament to shrink and tighten it. The stretched ligament shrinks to its normal size, thus returning stability to the knee.

Reconstruction of a torn ACL is significantly more involved and is accomplished through one of three methods, all of them arthroscopic: A portion of the patellar tendon is harvested (autograft) to create the new ACL. Two small portions of hamstring tendon are harvested (autograft) to create the new ACL. Donor tendon, or allograft, is used to create the new ACL. In all three methods, the new tendon is inserted through holes drilled in the tibia and femur, pulled through, and secured in position with bio-absorbable or metal screws. When the tendon is harvested from the patient, harvesting takes place at the same time as the reconstructive surgery. Limited Coding Options Several codes describe open ACL repair and reconstruction, but with the advent and domination of arthroscopy, the codes are largely obsolete. And arthro-scopic ACL repair or reconstruction has only one code: 29888 (Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction). According to the American Academy of Orthopaedic Surgeons' [...]