Orthopedic Coding Alert

Question: Our surgeon documented -mosaicplasty reconstruction of talar dome right ankle by open technique using synthetic bone grafts.- I-m aware of the knee mosaicplasty codes (29866-29867), but I-m not sure what to report for mosaicplasty of the ankle. Would you advise?


Arkansas Subscriber


Answer: CPT does not yet include a code for mosaicplasty of the ankle, during which the surgeon excises the chondral lesion of the ankle and then grafts cartilage into the lesion in a -mosaic--like fashion to stabilize the joint.

You should report 27899 (Unlisted procedure, leg or ankle) for the mosaicplasty, and ask your surgeon whether he thinks you should use 29866 (Arthroscopy, knee, surgical; osteochondral autograft[s] [e.g., mosaicplasty] [includes harvesting of the autograft]) or 29867 (... osteochondral allograft [e.g., mosaicplasty]) as the -comparison- code to set your fee. Also ask the physician to write a letter to the insurer explaining the procedure and why he performed it.

Some payers will not reimburse you for mosaicplasty of the ankle, although others (for example, several Aetna plans and Excellus BC/BS) will pay these claims. Ask your insurer for its ankle mosaicplasty policy in writing.