Orthopedic Coding Alert

Question: Operative notes indicate that after a level-four evaluation and management (E/M) service for a new patient, the surgeon performed a surgical lateral release on the patient’s right knee. I reported 29873-RT for the release, and got a denial. What did I do wrong?

Kentucky Subscriber

Answer: There are a couple of things that might have gone wrong with this claim; check out this breakdown of the correct procedure and E/M coding, and see if your coding matches up.

Lateral release: If you reported 29873 (Arthroscopy, knee, surgical; with lateral release) with modifier RT (Right side) on the claim and the payer denied, it could be that you simply chose the wrong lateral release code. Go back and check that you have the proper code for the proper surgical knee procedure.

There’s also a slight chance that the payer denied 29873 because you used the wrong laterality modifier; make sure the surgeon performed the procedure on the patient’s right knee, or you might have to resubmit with modifier LT (Left side).

If you did choose 29873 for this procedure and it was denied, there is also a chance that you should have coded the knee procedure differently. As the notes below 29873 indicate in CPT^® 2018, “For open lateral release, use 27425.”

According to Codify, 29873 involves examination of the “inside of the knee joint with an arthroscope to assess the fibrous tissues that hold the patella, or kneecap, in place. [The provider] incises the lateral retinaculum, the tight band of tissue on the outer aspect of the patella, to release excessive constriction that causes pain.”

The 27425 code, however, is for use when “the provider incises or divides the tight lateral retinaculum, a band of fibrous tissue on the outer side of the knee that supports the patella in its position against the thigh’s femur bone beneath it,” Codify states.

So, it is possible that you should have reported 27425 (Lateral retinacular release, open) instead of 29873.

Modifier alert: No matter which code you choose, you need to append modifier 57 (Decision for surgery) to 99204 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity …) in order to ensure E/M payment. Both 27425 and 29873 have global periods of 90 days, meaning any separate pre-procedure E/M needs modifier 57.