Orthopedic Coding Alert

Don't miss what the term -autograft(s)- reveals for 27416 and 29866 CPT 2008 brought you 27416, an all-new mosaicplasty code. That makes now the perfect time to study up on how to choose between osteochondral graft codes 27415, 27416, 29866 and 29867. Use these strategies, and you-re sure to choose the right code every time. Take a Look at New Code 27416 Before the 2008 arrival of 27416 (Osteochondral autograft[s], knee, open [e.g., mosaicplasty] [includes harvesting of autograft(s)]), CPT didn't offer a code for this open osteochondral autograft procedure, says Kathleen Nelson, CPC, professional coder for the orthopedics department at Fletcher Allen Health Care in Burlington, Vt. Instead, guidelines instructed coders to use 27599 (Unlisted procedure, femur or knee), Nelson says. She would also add a procedure descriptor and send it with the operative report to the insurance companies. Having a dedicated code for this procedure and not having to rely on an unlisted-procedure code is exciting, Nelson says. "We all know how difficult it is to get reimbursement on an unlisted code." But to be sure you-re using this new code correctly -- and distinguish it from similar codes -- you need to know whether the procedure is open or arthroscopic and whether the surgeon uses an autograft or allograft. Note how these elements apply to these descriptors: - 27415 -- Osteochondral allograft, knee, open - 27416 -- Osteochondral autograft(s), knee, open (e.g., mosaicplasty) (includes harvesting of autograft[s]) - 29866 -- Arthroscopy, knee, surgical; osteochondral autograft(s) (e.g., mosaicplasty) (includes harvesting of the autograft[s]) - 29867 -- Arthroscopy, knee, surgical; osteochondral allograft (e.g., mosaicplasty). This chart displays another way to look at it: Decide Between Autograft and Allograft Before you can choose the proper osteochondral graft code, you have to decide whether the surgeon used an autograft or allograft. Autograft: An autograft refers to a graft the surgeon takes from the patient, Nelson says. The surgeon should document where he harvested the graft from to help you determine that he used an autograft, Nelson says. If you don't see this documentation, check with the surgeon to be sure you-re choosing the proper code, she says. Tip: The surgeon often takes the autograft from a non-weight-bearing portion of the same knee. Codes 27416 and 29866 specify autograft in their descriptors. Note that both code descriptors state, "includes harvesting of autograft(s)," which means that you should not report a separate graft code, Nelson says. Allograft: An allograft comes from a donor other than the patient, most likely from a bone or tissue bank, Nelson says. The surgeon should document "allograft" and perhaps explain why an autograft was not sufficient, Nelson adds. Codes 27415 and 29867 specify the term "allograft" in their descriptors. [...]