Orthopedic Coding Alert

Question: Every time our practice bills 27425 (Lateral retinacular release [any method]) with 29881 (Arthroscopy, knee, surgical; with meniscectomy [medial OR lateral, including any meniscal shaving]), the lateral release is denied. I always append modifier -59 (Distinct procedural service) but it doesn't seem to help. Denver Subscriber Answer: Neither the CCI nor the American Academy of Orthopaedic Surgeons (AAOS) bundles these procedures, so modifier -59 should not be necessary. Contact your insurer directly and ask the representative specifically why the insurer is denying the lateral release claim. It is possible that your carrier requires that modifier -51 (Multiple procedures) be appended to the second code. Although most carriers automatically add this modifier on their own, some insurers require practices to append modifier -51 themselves. Please note that as of Jan. 1, 2003, 27425 will only reflect open surgeries, and thereafter you should report 29873 (Arthroscopy, knee, surgical; with lateral release).

See article # 1 "CPT Unveils New Arthroscopic Rotator Cuff Repair Codes for 2003"  for more information.