Helpful Codes For Cruciate Reconstruction With Allograft

The following coverage, coding, and payment information is provided for informational purposes only and should not be construed as legal advice. The information was compiled from various resources and is subject to change.

Providers should exercise independent clinical judgment when selecting codes and submitting claims to accurately reflect the services rendered. Providers are encouraged to contact third-party payers for specific information on their coverage, coding, and payment policies as payment for medical products and services is affected by numerous factors.

Typical Medical Policy Guidelines for Cruciate Reconstruction with Allograft

Allograft ACL reconstruction is considered medically appropriate for an individual who is not a candidate for autogenous transplantation due to ANY ONE of the following:

• Autogenous tissue has been compromised (e.g., by previous surgery, previous injury)
• Multi-ligament reconstruction is being performed
• Pathology such as chronic patellar tendonitis and hamstring injury exists

Ranges below indicate several options are available for the same procedure (e.g. left, right or bilateral).

Typical ICD-10 Codes

• M22.2X1-M22.3X9 – Patellofemoral disorders and other derangements of patella
• (including lateral, medial, anterior and posterior ligaments)
• M22.8X1-M22.8X9 – Other disorders of patella (including lateral, medial, anterior and posterior ligaments)
• M23.50-M23.52 – Chronic instability of knee (including lateral, medial, anterior and posterior ligaments)
• M23.601-M23.8X9 – Other spontaneous disruption of ligament(s) of knee and other internal derangements of knee (including lateral, medial, anterior and posterior ligaments)
• M76.50-M76.52 – Patellar tendinitis

Typical ICD-10 Procedure Code

• 0SUC0KZ-0SUD4KZ – Supplement knee joint with nonautologous tissue substitute

CPT Codes

• 27427 – Ligamentous reconstruction, knee; extra-articular
• 27428 – Ligamentous reconstruction, knee; intra-articular (open)
• 27429 – Ligamentous reconstruction, knee; intra-articular and extra-articular
• 29888 – Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction
• 29889 – Arthroscopically aided posterior cruciate ligament repair/augmentation or reconstruction

Typical HCPCS Codes

• C1762 – Billing code for allograft

Typical Revenue Codes (for form UB-04)

• 278 – Other implants

CPT Modifiers

Physicians may bill modifiers to indicate that a procedure performed has been altered by some specific circumstances, but not changed in its definition or code.

• 22 –Indicates an unusual procedure where additional reimbursement may be made if the payer agrees the procedure involved exceptional circumstances. This modifier will trigger manual review of the claim.
• RT – Right
• LT – Left

Updated on: 18/03/2021