Patricia Donegan
Contributor
My son had knee surgery several months ago. The surgeon's office submitted codes 27422 and 29873 to my insurance carrier. They paid well on
27422 but very little on 29873 (less than 10% of the fee) I appealed the decision, but they denied any more payment and I am left paying off a very large balance.(thousands of dollars) I am wondering if code 29873 is the correct code. The office is looking into this for me, I want to pay the surgeon ,but I also want to be sure my insurance company pays correctly on the surgery as well. I pay a lot for my coverage, and have rarely used it other than for well care visits. Here's the report, any ortho coder's insight would be greatly appreciated. I have been billing and coding for 20 years, I have my CPC, but my field is cardiothoracic. Thanks
Operation: Left knee medial patellofemoral ligament reconstruction for patella stabilizaiton and diagnostic arthroscopy with arthroscopic lateral release.
Findings: Diagnostic arthroscopy revealed chondral injury to the medial facet of the patella consistent with recurrent instability of the patella. The menisci PCL were intact, The ACL had continuity from the intercondylar notch lateral wall to the tibial footprint. However, it became attenuated at its femoral attachment indicating a partial tear dynamic. Lachman and pivot shift did demonstrate tensioning and functioning of the ACL.
Procedure: .......Standard anteromedial, anterolateral portals were created at the level of joint line by incising the skin and capsule. Diagnostic arthroscopy revealed the above noted findings. After thorough evaluation of the ACL, dynamic testing and examination under anesthesia, the decision was made to go forward with an MPFL reconstruction. There was a tight lateral retinaculum. The camera was introduced in the medial and lateral portal. The a 2cm incidiosn was made over the pes anserinus. Dissection was carried down to the pes. It was reflected at the division between the semitendinosus and gracilis and the semitendinosus was freed of soft tissue attachments controlled with #2 nonabsorbable suture, harvested brought on the back table. Muscle was removed, folded over, whip stitched and it had a 6mm diameter and the 2cm incision was made midway between the medial patella and teh medial epicondyle. The VMO was identified and an incision was made in the retinaculum from the medial epicondyle to the proximal 1/3 of the patella. The medial aspect of the patella was prepared for a tunnel. A pin was placed and a 6mm tunnel was drilled by 15mm and 2 divergent tunnels were drilled and teh graft was tensioned into these tunnels. The sutures passed through these tunnels and were retrieved out the medial portal and tied. Tensioning of the graft revealed excellent fixation. Then the knee was flexed and medial erpicondyle was exposed. The pin was placed just above the MCL and isometry was confirmed with fexion/extension. Then a 7 x 25 mm tunnel was drilled and the graft at its appropriate length was controlled with #2 nonabsorbale suture and a Biotenodesis driver was used to deliver the graft into the tunnel and a 7 x 23 screw was placed. This was with the knee held at 60 degrees of flexion. Following, there was a full range of motion. excellent stabilithy of the patella at this time and inability to dislocate the patella and no loss of motion. Then the redundant medial retinacular tissue was imbricated with 0 tycron suturues and this also advanced the VMO onto the MPFL reconstruction. The wounds were irrigated.......
27422 but very little on 29873 (less than 10% of the fee) I appealed the decision, but they denied any more payment and I am left paying off a very large balance.(thousands of dollars) I am wondering if code 29873 is the correct code. The office is looking into this for me, I want to pay the surgeon ,but I also want to be sure my insurance company pays correctly on the surgery as well. I pay a lot for my coverage, and have rarely used it other than for well care visits. Here's the report, any ortho coder's insight would be greatly appreciated. I have been billing and coding for 20 years, I have my CPC, but my field is cardiothoracic. Thanks
Operation: Left knee medial patellofemoral ligament reconstruction for patella stabilizaiton and diagnostic arthroscopy with arthroscopic lateral release.
Findings: Diagnostic arthroscopy revealed chondral injury to the medial facet of the patella consistent with recurrent instability of the patella. The menisci PCL were intact, The ACL had continuity from the intercondylar notch lateral wall to the tibial footprint. However, it became attenuated at its femoral attachment indicating a partial tear dynamic. Lachman and pivot shift did demonstrate tensioning and functioning of the ACL.
Procedure: .......Standard anteromedial, anterolateral portals were created at the level of joint line by incising the skin and capsule. Diagnostic arthroscopy revealed the above noted findings. After thorough evaluation of the ACL, dynamic testing and examination under anesthesia, the decision was made to go forward with an MPFL reconstruction. There was a tight lateral retinaculum. The camera was introduced in the medial and lateral portal. The a 2cm incidiosn was made over the pes anserinus. Dissection was carried down to the pes. It was reflected at the division between the semitendinosus and gracilis and the semitendinosus was freed of soft tissue attachments controlled with #2 nonabsorbable suture, harvested brought on the back table. Muscle was removed, folded over, whip stitched and it had a 6mm diameter and the 2cm incision was made midway between the medial patella and teh medial epicondyle. The VMO was identified and an incision was made in the retinaculum from the medial epicondyle to the proximal 1/3 of the patella. The medial aspect of the patella was prepared for a tunnel. A pin was placed and a 6mm tunnel was drilled by 15mm and 2 divergent tunnels were drilled and teh graft was tensioned into these tunnels. The sutures passed through these tunnels and were retrieved out the medial portal and tied. Tensioning of the graft revealed excellent fixation. Then the knee was flexed and medial erpicondyle was exposed. The pin was placed just above the MCL and isometry was confirmed with fexion/extension. Then a 7 x 25 mm tunnel was drilled and the graft at its appropriate length was controlled with #2 nonabsorbale suture and a Biotenodesis driver was used to deliver the graft into the tunnel and a 7 x 23 screw was placed. This was with the knee held at 60 degrees of flexion. Following, there was a full range of motion. excellent stabilithy of the patella at this time and inability to dislocate the patella and no loss of motion. Then the redundant medial retinacular tissue was imbricated with 0 tycron suturues and this also advanced the VMO onto the MPFL reconstruction. The wounds were irrigated.......