Orthopedic Coding Alert

Thermal anterior cruciate ligament (ACL) shrinkage is a new surgery that differs from traditional ACL reconstruction. Although less invasive than a reconstruction, the procedure requires significant work and expertise. But because thermal ACL shrinkage is a relative newcomer in orthopedics, no code exists to describe it accurately. As with so many techniques or services too new to have a CPT code, adequate documentation and comparative codes are the surest path to reimbursement.

An ACL Overview

ACL injuries are complete or partial tears to the ligament that provides stability in the knee. Although they can sometimes be treated conservatively, ACL injuries are often surgically corrected. The most common form of ACL repair is through arthroscopy (29888, arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction). During a traditional ACL repair for a complete tear to the ligament, a graft tendon is inserted in place of the damaged one.

Thermal ACL shrinkage is used to treat partial tears of the ligament that are due to stretching injuries. With arthroscopic guidance to visualize the operative site, 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.

Therefore, when patients have elongated but otherwise intact ACLs, thermal shrinkage is a less invasive procedure that avoids the use of drill holes, large incisions and the harvesting of ligament graft from the hamstring muscle.

Traditional ACL reconstructions take about two hours, and the thermal shrinkages take about 45 minutes to one hour. Some orthopedic surgeons use 29888 to code for the procedure, but questions have arisen as to whether there is a more appropriate code. Carrier reactions to 29888 for thermal shrinkages have been mixed. Yet for coding, 29888 appears to be the closest match. The ACL is still reconstructed using the thermal probe, but the thermal shrinkage does not use an allograft or autograft as is traditionally done in an ACL reconstruction.

Coding Options

Of existing CPT codes, 29888 comes closest to describing the thermal shrinkage procedure, but only in the sense that both procedures repair a damaged ACL. According to the AAOS Complete Global Service Data for Orthopedic Surgery, 29888 includes harvesting and insertion of fascial, tendon or bone graft. Because thermal shrinkage does not include a graft component, the procedure takes half the time of a traditional repair. Therefore, if using 29888, modifier -52 (reduced services) should be appended with a note explaining how the procedure performed differs from 29888.

The downside to using the -52 modifier is that it may mean a substantial reduction from the original procedure. Rather than making the reduction before submitting [...]