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Orthopedic Coding Alert

Overcoming Problems Coding Multiple Knee Ligament Repairs

"Multiple ligament repairs can be a real challenge for a coder unless he or she has a thorough understanding of arthroscopic families and the proper use of modifier -51 (multiple procedures) to indicate that more than one procedure was done at one session.

Knee ligament injuries are not unusual. For example, on Jan. 1, the University of Texas (Austin) Longhorns not only lost the Cotton Bowl to the University of Arkansas, they also lost their star quarterback, Major Applewhite, to a torn anterior cruciate ligament (ACL).

Repair of the ACL and rehabilitation will keep Applewhite off the field (and out of spring practice) for six months. Knee ligaments (see box on page 3), particularly the ACL, are vulnerable to injuries caused by excessive twisting (rotation). At the same time, the meniscus cartilage between the femur and the tibia is prone to being squished and dislodged by trauma.

Applewhite's high-visibility misfortune is actually a common one among athletes on the field and on the slopes. About 15 percent of people who damage an ACL also damage another ligament or the meniscus.

Note: For a discussion of coding for ACL repair alone, see page 84 of the November 1999 Orthopedic Coding Alert.

Multiple Ligament RepairsSimple Cases

Coding for arthroscopic ACL or posterior cruciate ligament (PCL) repair/augmentation or reconstruction is relatively easy, thanks to the contingencies built into the respective codes, explains a physician familiar with multiple procedures. The physician uses 29888 (arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction) for ACL and 29889 (arthroscopically aided posterior cruciate ligament repair/augmentation or reconstruction) for PCL.

When ACL and PCL repair/augmentation or reconstruction are done during the same operating room (OR) session, a -51 modifier would be attached to the higher paying or higher fee procedure (Medicare Part B guidelines), and it would be listed first. Some coders would also use a -59 modifier (distinct procedural service) on the second procedure to indicate that the procedure was separate from other services.

Note: See page 90 of the December 1999 Orthopedic Coding Alert for a discussion of the advantages and limitations of using modifiers -51 and -59 together.

Open procedures for cruciate ligaments are covered by 27405 to 27409 (repairs) and by 27427 to 27429 (ligamentous reconstruction/augmentation). It is legitimate to code for primary repair of ligament(s) performed in addition to reconstruction if arthrotomy is used for the approach.

For example, for primary ACL repair and reconstruction of a PCL, the correct coding is to report 27407 (repair, primary, torn ligament and /or capsule knee, cruciate) and 27428 (ligamentous reconstruction, augmentation, knee, intra-curricular). Arthroscopic codes 29888 and 29889 cannot be reported when 27427 to 27429 are reported. This goes back to [...]

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