Cpt code bone grafting tibial tunnel. Protrusion of bone graft matrix from tunnels is leveled.
Cpt code bone grafting tibial tunnel. ) Aug 31, 2012 · If not included in the CPT code description (27724) for nonunion, it would be 20902 for major or large bone graft. Bone Graft related CPT Codes. Apr 17, 2009 · For Stage 1, since there is no code for a REVISION arthroscopic ACL reconstruction or for the tunneling bone graft, we reported unlisted code 29999 with comp code 11044-22 for debridement of the graft plus placement of a new allograft. Code +20933 may be reported with primary tumor removal procedures 23210, 23220, 24150, 25170, 27075, 27076, 27077, 27365, 27645, and 27704. Bone graft, any donor area; minor or small eg, dowel or button) (20900) Bone graft, any donor area; major or large (20902) Insertion vascular pedicle into carpal bone (25430) Bone marrow; aspiration only (38220) Bone marrow transplantation; autologous (38241) Microvascular. It's not going to be an autograft from a separate site, so 20902 is out I guess. the techniques used to perform grafting of ACL femoral or tibial tunnel defects. THEN COMBO OF CORTICOCANCELLOUS BONEGRAFT AND GRAFTON PUTTY WAS PLACED INTO THE ANTERIOR TUNNEL. He removed other hardware, so we coded 20680. However, an absolute threshold for how much tunnel-widening and bone loss is acceptable to undergo a single stage with an intraoperative bone graft prior to drilling has not been established [4, 16,17,18,19]. Oct 31, 2019 · I need help with coding the following procedure as soon as possible: Preoperative Diagnosis: INSTABILITY RIGHT KNEE Postoperative Diagnosis: INSTABILITY RIGHT KNEE Procedure Performed: Bone grafting of the femur and tibial tunnels as a stage procedure for future ACL reconstruction 5 days ago · What code(s) would be reported for the open removal of retained deep hardware, along with placement of bone graft to the femur and tibial tunnels? Is it appropriate to assign codes for both the arthroscopic and open portions of the procedure? Sep 28, 2020 · Procedure for ACL was Debridement ACL Graft. A patient who previously underwent an open reduction, internal fixation (ORIF) due to an ankle fracture presented with collapse of the fracture with displacement, hardware failure and a syndesmosis disruption. Diagnostic arthroscopy (29870) — with or without biopsy. A problem that is frequently encountered during endoscopic anterior cruciate ligament reconstruction bone-patellar tendon-bone autograft is that the graft is often too long and protrudes from the tibial tunnel. Aug 17, 2024 · The bone graft is dispensed through the tibial tunnel until visualized arthroscopically. We then placed 2 allograft bone dowels and impacted them into place with a nice press-fit using the dilator. The femoral tunnel was a little high. Tunnel widening is generally cavitary, frequently maximal in the mid-zone of the tibial tunnel. I would look at billing 29877 for the debridement of the soft tissue. Protrusion of bone graft matrix from tunnels is leveled. The femoral tunnel was easily visualized with flexing the knee beyond 90 degrees. The previous ACL graft was debrided with the use of a shaver. Bone graft with microvascular anastomosis It is technically difficult to deliver and impact bone graft into the femoral tunnel with the standard surgical and arthroscopic instruments. It is important to ensure that the procedure meets the criteria outlined in the code description. We describe a new technique for femoral and tibial tunnel impaction grafting in 2-stage ACL revisions, using the OATS grafting instruments (Osteochondral Autologous Transfer System; Arthrex, Naples, FL). These graft choices include autologous reamer-irrigator-aspirator (RIA) harvested bone from the femur,7,8 autologous iliac crest or prox-imal tibia bone graft cores,9 allograft bone dowels,10,11 and synthetic dowels. The extent of the procedure is determined by provider documentation. Feb 13, 2008 · A pt of ours has an old ACL reconstruction that needs to be redone, but 1st, my doc is going to do an open bone graft of the tibial tunnel - his tentative plan - to "dig out" bone, mix it with DBX & pack it back in. If less than 20 mm of the bone plug remains in the tibial tunnel, interference screw fixa … Apr 3, 2019 · and then used a curette, shavers and reamers to clean out the previous femoral tunnel. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples. 3. We then placed a guide wire into the tibia and first dilated and then sequentially reamed up to a size 9. When bone grafting the tibial tunnel, the knee is extended, and a key elevator is inserted through the anteromedial portal and placed over the tibial tunnel to block graft from Jan 27, 2017 · DR STATES HE DEBRIDED THE TUNNEL AND THEN A UNICORTICAL DOWEL WAS PLACED INTO THE POSTERIOR TUNNEL. Of note, both bone Dec 13, 2021 · Multiple allograft and autograft options exist, as do the techniques used to perform grafting of ACL femoral or tibial tunnel defects. 5 reamer. 12 Grafts can be introduced into Oct 27, 2023 · Using the prior incision for the tibial tunnel, the process of hardware removal, biopsy, and tunnel debridement is repeated in a similar fashion to the femoral tunnel. This is an ACL reconstruction being done in two stages, the ligament graft was not performed Sep 20, 2024 · The PL bone tunnel was drilled anatomically via the accessory medial portal, but the femoral AM bone tunnel was drilled via the tibial tunnel resulting in a nonanatomic anterior (“high AM”) position once again; and (d, e) as our knowledge of anatomy has continued to improve, surgical techniques have resulted in more anatomic placement on Nov 13, 2024 · AHA Coding Clinic ® for HCPCS - 2019 Issue 4; Ask the Editor Nonunion repair of the tibia with autologous bone graft. • The fibula removed and utilized for bone graft • Percutaneous calcaneal bone graft performed mixing allograft bone graft in a mill • Bony edges prepared using a saw blade 21 Case Study 3 - What •Bur used to prepare the nonunion site •Medial incision made to prepare medial gutter •Cannulated screws placed across the arthrodesis site. 26 Use of outside-in instrumentation for the femoral tunnel reduces the risk of overlap, helping to control the intra- and extra-articular positioning and reduces the risk of Apr 5, 2019 · Code +20933 describes partial (hemicylindrical) bone allograft, while +20934 describes complete (cylindrical) allograft. A femoral bone graft is dispensed through a cannula until impacted and even margins are maintained (B). Expected immediate post-operative ACL tunnel diameter should be around 10 mm regardless of graft selection. (LFC, lateral femoral condyle; MFC, medial femoral condyle. These graft choices include autologous reamer-irrigator-aspirator (RIA) harvested bone from the femur, 7, 8 autologous iliac crest or proximal tibia bone graft cores, 9 allograft bone dowels, 10, 11 and 1. CPT code 20900 should be used when a bone graft procedure is performed to restore missing or damaged bones. He then "widened" the anteromedial portal and packed bone graft into the femoral tunnel defect. care is taken to ensure that all bone graft is carefully placed into the tunnel. It was filled in its entirety. 92 27640 Partial excision (craterization, saucerization, or diaphysectomy), bone (eg, osteo-myelitis); tibia Sep 12, 2023 · The PL bone tunnel was drilled anatomically via the accessory medial portal, but the femoral AM bone tunnel was drilled via the tibial tunnel resulting in a nonanatomic anterior (“high AM”) position once again; and (d, e) as our knowledge of anatomy has continued to improve, surgical techniques have resulted in more anatomic placement on Nov 3, 2020 · Fig 7 Image of right leg demonstrating bone grafting of the tibial tunnel in an outside-in fashion using a modified 3-cc syringe with tip cut off and plunger retained to place bone graft via medial tibial metaphysis. Allograft bone grafting femoral an Tibial Tunnels, with Debridement of Tunnels. The tibial bone tunnel is filled up by the PRO-DENSE Injectable Regenerative Graft, while the articular opening of the bone tunnel is covered with a bone curette of appropriate size via the Sep 18, 2019 · Previous literature has reported that if the tunnel size exceeds 10–15 mm, two-stage surgery should be performed. The Partial excision (craterization, saucerization, or diaphysectomy) bone, femur, proximal tibia and/or fibula (eg, osteomyelitis or bone abscess) N/A $936. In cases like these your going to need to bill out "what you can" which in this case would be 20680. CPT code 20902 describes the procedure for bone grafting, specifically for major or large bone defects. Thanks PREOPERATIVE DIAGNOSIS Left knee failed anterior cruciate • The fibula removed and utilized for bone graft • Percutaneous calcaneal bone graft performed mixing allograft bone graft in a mill • Bony edges prepared using a saw blade 21 Case Study 3 - What •Bur used to prepare the nonunion site •Medial incision made to prepare medial gutter •Cannulated screws placed across the arthrodesis site Jan 27, 2014 · Need CPT for Knee arthroscopy w/removal of hardware & bone graft of tunnels, no ACL repair was performed, just basically debridement with bone graft of the old tunnels. 2. The defect on the tibial side was not large enough to need to be bone grafted. A key elevator can be placed intraarticularly to occlude the plateau side of the tunnel to prevent graft impaction into the joint Jan 2, 2022 · The tibial bone tunnel is dried up with peanut swab via its distal tibial cortical opening and then, the delivery needle is inserted in the bone tunnel. The provider wanted to use a bone harvesting code (20900, 20902). One of the main factors associated with tunnel enlargement is malposition of the tibial tunnel, which likely leads to graft Oct 11, 2021 · A widened tunnel or overlapping between the existing and new tunnel can compromise the tendon graft fixation and, thereby, require two-stage revision with a bone graft. Apr 27, 2009 · Hi, Could someone help with the CPT coding for hospital facility billing of the CPT codes? How do you capture the bone grafting of the femoral and tibial tunnel? I get 29888 and 29881 for the rest of the services provided. Sep 8, 2019 · There is no code for bone grafting. 10 27635 Excision or curettage of bone cyst or benign tumor, tibia or fibula; N/A $595. Dec 6, 2009 · Removal of the damaged portion of meniscus, creation of tibial tunnels or bone trough, and insertion and securing of meniscal graft. Next, the tibial tunnel is pre-pared, and a large curette is inserted through the anteromedial portal to provide a “roof” while the graft is impacted into the tunnel to ensure residual bone graft does not end up in the knee joint (Figs 7 and 8). Dec 23, 2014 · identified the tibial tunnel and with the rongeur and curette removed disintegrating absorbable screw.