• Knee Cartilage Repair

    July 2019

    There are many procedures performed for repair of knee cartilage defects, many of which are reported with unlisted CPT code 27599.   Remember that it is not appropriate to report a procedure that is “close to” the actual service performed but that is normally what happens.

    The service that I want to discuss is based on an April 2019 FAQ in CPT Assistant.   The question is whether or not CPT code 27415 Osteochondral allograft, knee, open can be reported for the following type of procedure.

    The physician makes an approach through a medial parapatellar arthrotomy. After reflecting the patella there is a chondral lesion on the trochlea.   To repair this a microfracture is first performed within the confines of the defect.   Blood is then obtained and spun down to obtain PRP (platelet rich plasma) which is then mixed with an allograft cartilage paste and then subsequently injected into the cartilage defect.

    The AMA has stated that this service is not representative of CPT code 27415 because a cartilage paste is being injected and this differs significantly from the intended purpose of code 27415 which is reported when an allograft plug is prepared, cut and fit into the defect.   The recommended coding for this procedure is 27599 and 0232T.

    However, I disagree with 0232T.   Whether you have bone marrow or blood that is spun down for PRP it still codes to 0232T.   If you look at the parenthetical notes under CPT code 20939 it states that for an INJECTION of PRP you would report 0232T, but an injection wasn’t performed in this FAQ.   What was performed was mixing of the PRP with the allograft cartilage paste and there is a separate parenthetical note indicating that when mixed for the purpose of grafting during an orthopedic procedure you would report 20999 Unlisted procedure, musculoskeletal system, general.