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SuperCoder Posted 6 Year(s) ago

ACL reconstruction using hamstring quadrupled autografts with EndoBurton on the femur and a BioComposite interference screw on the tibia, and partial lateral meniscectomy zones E and F.

SuperCoder Posted 6 Year(s) ago

a code from the 27427-27429 series (Ligamentous reconstruction [augmentation], knee -), depending on whether the repair was extra-articular (27427), intra-articular (27428) or both intra-articular and extra-articular (27429).

graft from same extremity is included

meniscetomy is 27403-51 if to a payer that does not follow CCI edits.

Jen Godreau, CPC, CPMA, CPEDC

SuperCoder Posted 6 Year(s) ago

what happens when the physician reconstructs intra-articular ACL and extra-articular PCL. The physician wants to code 27427 and 27428 which bundles - but can be overridden with modifier 59. As well CPT code 27429 is for intra and extra articular reconstruction. Would this code be usable for different ligaments. Is this code differentiated by sites (ACL vs PCL)??

SuperCoder Posted 6 Year(s) ago

First of all, physician's code selections are incorrect. Physician should not report both 27427 and 27428 for this scenario. Still, as per latest CCI edits version 18.0, there are no bundled between codes 27427 and 27428. Therefore, modifier -59 is not applicable between these codes. If both ACL vs PCL has been reconstructed, physician should only bill 27428 two times with modifier -59 appended with second code, not 27427 or 27429. So billing should be like this:
27428
27428-59
Sometimes, when repairing an ACL, the physician may chose to combine an intra-articular repair (ie, bonepatella- bone) with an extra-articular repair (ie, hamstrings). In that case code 27429, Ligamentous reconstruction (augmentation), knee; intra-articular, (open) and extra-articular, is the correct code to report.

Posted by SuperCoder, 6 Year(s). There are 4 posts. The latest reply is from SuperCoder.

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