Orthopedic Coding Alert

Question: How do you code open excision of un-united ossicle in a patient with Osgood-Schlatters disease (732.4, juvenile osteochondrosis of lower extremity, excluding foot). The physician makes an incision over the patellar tendon and down to deep fascia. The patellar tendon sheath is incised directly over the ossicle, which is a loose fragment. This is removed and debridement at the attachment of the patellar tendon is done to smooth a prominent shelf. What CPT code best describes this procedure?

Danielle Katherine
Vancouver, Wash.

Answer: The variety of CPT codes Ive seen orthopedic surgeons bill for a procedure confirms that no existing codes accurately describe the surgery. I asked three surgeons to choose a CPT code for removal of an Osgood-Schlatters ossicle. Not surprisingly, I got three different responses 27350 (patellectomy or hemipatellectomy), 27328 (excision, tumor, thigh or knee area; deep, subfascial, or intramuscular) and 27599 (unlisted procedure, femur or knee). I believe the correct answer is 27599. Code 27350 may seem a good choice because the surgical approach is the same, but this is a more extensive procedure involving complete or partial removal of the patella. Code 27328 is a poor choice as this describes the removal of a soft tissue mass, not a bony ossicle.

When reporting an unlisted procedure code, remember to submit a special report with the claim. Include information that describes the technical aspects of the procedure, as well as the time, effort, expertise, and equipment needed to provide the service.