Helpful Codes For Osteochondral Allograft Procedures In The Distal Femur

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. to individual patients. 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.

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

Typical ICD-10 Codes

M12.561-M12.569 – Traumatic arthropathy
M17.0-M17.9 – Osteoarthritis of knee, degenerative joint disease
M22.90-M22.93 – Unspecified disorder of patella
M23.50-M25.369 – Chronic instability, flail joints
M23.000-M23.92 – Internal derangement of knee
M23.8X1-M23.8X2 – Other internal derangements of knee
M25.561-M25.569 – Pain in knee
M87.051-M87.059 – Idiopathic aseptic necrosis of femur
M87.151-M87.159 – Osteonecrosis due to drugs, femur
M87.251-M87.256 – Osteonecrosis due to previous trauma, femur
M93.261-M93.269 – Osteochondritis dissecans of knee
M93.861-M93.869 – Other specified osteochondropathies of lower leg
M94.261-M94.262 – Chondromalacia
M94.8X6 – Other specified disorders of cartilage
M94.9 – Disorder of cartilage, unspecified
M99.86 – Other biomechanical lesions of lower extremity
S89.80XA-S89.82XS – Other specified injuries of lower leg
S89.90XA-S89.92SX – Unspecified injuries of lower leg

Typical ICD-10 Procedure Code

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

CPT Codes

27415 – Osteochondral allograft, knee, open
27599 – Unlisted procedure, femur or knee
29867 – Arthroscopy, knee, surgical; osteochondral allograft
29999 – Unlisted procedure, arthroscopy

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 may be used for patients with multiple defects, and will trigger manual review of the claim.
RT – Right
LT – Left

Note: These lists of codes may not be all-inclusive.

Updated on: 21/10/2021