Hip and Knee Coding Insights: Navigating Patellofemoral Procedures
Paul Cadorette, CPC, COC, CPC-P, COSC, CASCC, Director of Education, nimble solutions
Join Paul Cadorette on July 18th at 1pm Central for the Hip and Knee Orthopedic Surgery Coding Webinar. Register here.
I hope you’ll join me in the upcoming Hip and Knee Orthopedic Surgery Coding Webinar, where I’ll delve into the complex coding issues associated with these procedures, including recent coding updates for ASCs.
In this blog post, I’ll review recent coding updates specifically related to patellofemoral procedures. I’ll dive deeper into these topics during the webinar.
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
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.
Join the webinar for more in-depth coding insight
If you’re eager to dive deeper into orthopedic surgical coding for hip and knee procedures, I invite you to join our upcoming webinar.
Webinar Details
Title: Hip and Knee Orthopedic Surgery Coding
Date: Tuesday, July 18
Time: 1:00pm Central Time
Duration: 1 hour
Register here: https://bit.ly/3pm1n1F
This webinar is also an opportunity to receive AAPC continuing education units. You’ll be able to ask questions and further enhance your coding proficiency.
The evolving nature of coding recommendations from the AMA and AHA Coding Clinic highlights the need for ongoing education for ASC coders. I hope this blog post has given you a glimpse into the challenges and solutions surrounding these updates. Remember to join our upcoming webinar for a more in-depth exploration of orthopedic coding techniques and strategies that will strengthen your coding skills. Register today.
About the Author
Paul Cadorette is an accomplished professional in the field of medical coding, serving as nimble’s Director of Training and Education. With a passion for education and extensive experience, Paul provides comprehensive training and resources to ASC coding professionals, helping them navigate the complexities of medical coding and revenue cycle management. His deep understanding of coding guidelines, documentation requirements, and best practices, particularly in the specialized area of hip and knee coding, enables him to deliver authoritative insights and practical recommendations. With a reputation for effectively translating complex coding concepts, Paul is dedicated to empowering coding professionals to enhance their coding skills and optimize revenue cycle outcomes, ensuring accurate reimbursement in an ever-changing healthcare landscape.
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