Billing codes

The following coverage, coding, and payment information is provided for informational purposes only and should not be construed as legal advice.

The information has been compiled from various resources and is subject to change. Providers should exercise independent clinical judgment when selecting codes and submitting claims to reflect accurately the services rendered to individual patients.

Third-party payment for medical products and services is affected by numerous factors. Providers are encouraged to contact third-party payers for specific information on their coverage, coding, and payment policies.
 

Biopsy Procedure Codes

*This document is not intended to be a directive, nor is it a suggestion about the likelihood of obtaining reimbursement. This list is not all inclusive, and physician and staff may deem other codes more appropriate. Providers are responsible for selecting coding options that most accurately reflect a patient's condition, the provider's system guidelines, payer requirements and services rendered.

Typical ICD-9 codes

  • 717.9     Unspecified internal derangement – knee
  • 719.96   Unspecified disorder of joint – knee
  • 732.7     Osteochondritis dissecans
  • 733.90   Disorder of bone & cartilage, unspecified
  • 733.92   Chondromalacia (excludes patella)
  • 836.0     Tear of medial cartilage or meniscus – knee
  • 836.1     Tear of lateral cartilage or meniscus – knee
  • 836.2     Other tear of cartilage or meniscus – knee

Example of CPT codes

  • 29870 Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)
  • 29874 Arthroscopy, knee, for removal of loose body or foreign body (e.g., osteochondritis dissecans fragmentation, chondral fragmentation)
  • 29877 Arthroscopy, knee, debridement/shaving of articular cartilage (chondroplasty)
  • 99070 Supplies and materials (except spectacles) provided by physician over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided)

Implantation Procedure Codes

Autologous Chondrocyte Implantation CPT Code

The American Medical Association (AMA) has issued a unique and permanent Category I CPT Code for autologous chondrocyte implantation (ACI), effective January 1, 2005. The exact terminology is as follows:

27412: Autologous Chondrocyte Implantation, Knee

Please use the above code for Carticel implantation.

Typical concomitant CPT codes

  • 27418 Tibial tubercle transfer or osteotomy
  • 27420 MPFL reconstruction
  • 27457 High tibial osteotomy
  • 29868 Meniscal allograft reconstruction
  • 29888 Arthroscopic ACL reconstruction

Important notes for physician offices

  • Reimbursement will depend upon the contract with the insurer. The physician may want to consult with the insurer’s contracting representative to determine how the contract may affect reimbursement.