Wiki Lemaire Procedure

[dimplez]

Hello all, there was a previous thread on here dated 02.2021 that gave the direction to report CPT 27427 for the Lemaire procedure. However, the ITB is NOT a ligament of the knee, it is a tendon of the knee and the surgeon clearly states that they are doing a tenodesis. I have pointed these two issues out to my compliance department who are bit reluctant to agree. Can anyone lead me to how they are reporting this procedure? Resources would be appreciated as well.

https://www.arthrex.com/resources/V...-using-a-double-knotless-knee-fibertak-anchor

Thank you for your time,
Marisa

 

[Orthocoderpgu]

Hello all, there was a previous thread on here dated 02.2021 that gave the direction to report CPT 27427 for the Lemaire procedure. However, the ITB is NOT a ligament of the knee, it is a tendon of the knee and the surgeon clearly states that they are doing a tenodesis. I have pointed these two issues out to my compliance department who are bit reluctant to agree. Can anyone lead me to how they are reporting this procedure? Resources would be appreciated as well.

https://www.arthrex.com/resources/V...-using-a-double-knotless-knee-fibertak-anchor

Thank you for your time,
Marisa

I have been coding orthopedic surgeries for over ten years now. I have personally not seen this procedure yet which surprises me. However doing a bit of research leads me to believe you. I don't know why your compliance department would not agree. Code 27427 is for an extra-articular replacement/augmentation of a ligament using a graft. The ITB is a tendon, and it's not being augmented with a graft. I can understand why performing a tenodesis of the ITB would be performed since it would stop the "snapping" motion that would bother the patient, but I would never consider using 27427 to report a tenodesis of the ITB tendon.

 

[amyjph]

Ok, so from a little reading, is this being done at the same time as an ACL repair/reconstruction or revision repair to help stabilize the ACL repair/knee? It is not a stand alone procedure? If it is augmenting the ACL repair/done in conjunction it's not 27427 unless they are also doing extra-articular ligaments like maybe in a big knee blowout. That link you shared, at the beginning he even states "in combination with ACL". They are harvesting the ITB to use to help reinforce or stabilize by shuttling it under the FCL (in the example I saw).
I would say it would probably be 29888-22 with documentation in the op report to justify the 22 because of the additional work. Other than that, I think you would have to code it unlisted if it's in conjunction with an ACL.
I agree, it is not 27427. That is open extra-articular ligament reconstruction which is not what Lemaire is (for the ACL) (from my brief reading). I think it's the same idea now as how they sometimes do the ALL at the same time to augment the ACL.

27427 would be if they repaired the MCL for example, sometimes I think they do use a piece/strip of the IT band for doing those or possibly reconstructing the LCL/MPFL. I think it depends on the main procedure being done and why they are using the ITB. They are not repairing the ITB, they are using it to repair/augment a ligament.

Do you have an example case redacted?

 

[BLumetta]

CPT Assistant, May 2017 Page: 10 Category: Frequently Asked Questions

Surgery: Musculoskeletal System

Question:

Is it appropriate to report codes 29888 for arthroscopically aided anterior cruciate ligament (ACL) repair and 27427 for open reconstruction (with graft) of the medial collateral ligament of the knee when performed at the same operative session?

Answer:

Yes, code 27427, Ligamentous reconstruction (augmentation), knee; extra-articular, is an example of a service not included in the global service package for code 29888, Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction. Therefore, codes 27427 and 29888 may be reported for the same operative session. Modifier 51, Multiple Procedures, should be appended to the additional procedure to indicate that multiple procedures were performed during the same session.

Also see:
CPT Assistant, March 2024 Page: 24 Category: Questions and Answers
Questions and Answers
Surgery: Musculoskeletal System

Question: Would it be appropriate to report code 27427 or 27599 for a lateral extra-articular tenodesis or modified Lemaire procedure of the knee?

Answer: It would be appropriate to report code 27427, Ligamentous reconstruction (augmentation), knee; extra-articular, for a lateral extra-articular tenodesis or modified Lemaire procedure.