Orthopedic Coding Alert

Question: Our patient had a failed arthroscopic ACL reconstruction.  Staged revision was recommended.  In the first procedure, the surgeon removed hardware, old tissue graft from femur and tibial tunnels, and filled these tunnels with cylinder cancellous bone graft and bone putty.  We are assuming the 2nd stage will be reconstruction of the ligaments.  How do we report this?

Iowa Subscriber

Answer: If your surgeon did an open procedure, then you would report code 20680 (Removal of implant; deep [eg, buried wire, pin, screw, metal band, nail, rod or plate]) for the hardware removal. If your surgeon does it arthroscopically, you will report 29999 (Unlisted procedure, arthroscopy). You report code 29874 (Arthroscopy, knee, surgical; for removal of loose body or foreign body [eg, osteochondritis dissecans fragmentation, chondral fragmentation]) for the removal of the old tissue graft if your surgeon did the removal arthroscopically. If your surgeon adopted an open procedure to remove the old tissue graft, you report code 27331 (Arthrotomy, knee; including joint exploration, biopsy, or removal of loose or foreign bodies). For the bone grafting of the tunnels, you report 29999 or 27599 (Unlisted procedure, femur or knee).