Having done more research on the possible CPT Codes for use in this case, the more difficult it is to solve. As it turns out, the final pathology was that the lesion was malignant. But, none of the codes for treatment of a malignant lesion of the distal femur apply as they require "radical resection" of the lesion, which was not done in this case. The procedure actually done is best described in the codes for treatment of a benign tumor or lesion, i.e. "curettage" of the lesion in the distal femur. The 27355 code alone is not adequate by itself since the remaining cavity was filled with cement. However, Cement is not an Allograft or Bone Substitute (which would be defined as a material that would eventually be converted to bone in the long term healing process of the lesion), so although 27356 is not totally correct either, it is the closest to what was done. I think that in order to add 27358 to 27355 it would require that some form of metal fixation would have to have been placed in addition to the cement. After cogitating on it, my best thought is to use 27599: Unlisted procedure of the femur, and pair it to 27356. I would justify that by the fact that the lesion turned out to be malignant, none of the procedure codes for malignant lesions are correct, and the closest procedure to what was in fact done was 27356. Of course, send all the documentation you have.
I would be interested to know what others might think/suggest.
Sincerely, Alan Pechacek, M.D.