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

Updated on: 21/10/2021