Hip and Knee Coding Insights: Navigating Patellofemoral Procedures
By Paul Cadorette, CPC, COC, CPC-P, COSC, CASCC, Director of Education, nimble solutions
Watch the Anatomy of Coding: 2023 Hip and Knee Procedures coding course on demand. Register here.
In this blog post, I’ll review recent updates to ASC patellofemoral coding, specifically for hip and knee procedures. While these updates have caused some confusion recently, the following recommendations will help you avoid claim delays and denials when coding for patellofemoral surgeries.
Reconstruction of the PTFL (Patellofemoral Ligament)
The initial coding recommendation from the American Medical Association (AMA) for PTFL reconstruction was CPT code 27422, which involves the reconstruction of a dislocating patella with extensor realignment and/or muscle advancement or release. However, there was subsequent confusion regarding the appropriate code.
AMA’s first response was challenged when another inquiry arose, leading to a change in their recommendation.
They then suggested using CPT code 27427, which is designated for the reconstruction of an extra-articular ligament. AHA Coding Clinic also followed suit with this advice.
Eventually, the AMA and AHA Coding Clinic agreed that the patellofemoral ligament should not be classified as an extra-articular ligament. The AMA reverted back to their initial recommendation, suggesting the use of CPT code 27422 for PTFL reconstruction.
On the other hand, AHA Coding Clinic took a different approach and now recommends CPT code 27566, open treatment of patellar dislocation, with or without partial or total patellectomy for PTFL reconstruction.
Recommendation: Considering the AMA’s original coding recommendation, it is advisable to report CPT code 27422 for PTFL reconstruction until further updates or clarifications are provided.
Patellofemoral Arthroplasty: CPT Code 27438 or 27599?
For patellofemoral arthroplasty, which involves both patellar arthroplasty and resurfacing of the trochlear groove, a recent coding change has caused some uncertainty among coders.
Initially, the AMA recommended reporting CPT code 27438 for arthroplasty of the patella, along with CPT code 27599, an unlisted procedure code for the knee. However, the AMA has since revised its recommendation.
According to the updated guidance, the appropriate coding for patellofemoral arthroplasty is indicated by reporting only the unlisted procedure code 27599.
The AMA justifies this change by stating that performing a patellar arthroplasty alone (27438) involves less work compared to a patellofemoral arthroplasty. Additionally, there is no existing CPT code specifically for resurfacing the trochlear groove, making it necessary to report the unlisted code.
Recommendation: Following the revised recommendation from the AMA, it is advised to use the unlisted procedure code 27599 for patellofemoral arthroplasty until specific codes are introduced to accurately represent the resurfacing procedure of the trochlear groove.
This blog post outlines some of the topics covered in the 2023 Hip and Knee Procedures coding course, available on demand with corresponding AAPC continuing education units included.