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Knee Ligament Reconstruction

Editor's Note: This article by Paul Cadorette, director of education for mdStrategies, originally appeared in The Coding Advocate, mdStrategies free monthly newsletter. Sign-up to receive this newsletter by clicking here.

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There are two sets of ligaments that stabilize the knee joint. The medial and lateral collateral ligaments are known as extra-articular ligaments because they are located outside the joint. The anterior and posterior cruciate ligaments are located within the joint so they are termed inta-articular ligaments. In instances when a patient sustains a serious knee injury it may be necessary to reconstruct both the ACL and PCL. The CPT code for this procedure reads "Ligamentous reconstruction (augmentation), knee; intra-articular (open)." Since there is no mention of one or more ligaments, how should this code be reported?

A recent article in CPT Assistant (April 2009) instructs coders to report CPT code 27428 for reconstruction of the ACL and 27428-59 for reconstruction of the PCL, so it would be appropriate to report this code one time for each ligament that is reconstructed.

The information provided should be utilized for educational purposes only. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.

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