Specialized Toolkit Series: ACL Reconstruction-Coding ACL Reconstruction and Commonly Associated Procedures

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This document provides an in-depth overview of coding strategies for anterior cruciate ligament (ACL) reconstruction and associated procedures. The primary code for arthroscopic ACL reconstruction is CPT 29888, regardless of whether the procedure involves a primary repair or reconstruction with an allograft or autograft.<br /><br />Meniscus surgery, which often coincides with ACL procedures, has separate CPT codes: 29880 (meniscectomy medial and lateral), 29881 (meniscectomy medial or lateral), 29882 (meniscus repair medial or lateral), and 29883 (meniscus repair medial and lateral). If a meniscus is both repairable and irreparable, the codes 29882-51 and 29881-59 should be used with appropriate modifiers to indicate multiple or distinct procedures.<br /><br />Chondral injuries are also common and are coded based on the specific tasks performed. Simple chondroplasty is covered by 29877. In ACL reconstruction, cartilage procedures like osteochondral autografts (29866), allografts (29867), abrasion arthroplasty (29879), and drilling for osteochondritis dissecans (29885, 29886, 29887) have their own distinct codes.<br /><br />Loose body removal is coded as 29874 but is only billable if the loose body meets specific criteria such as size or the requirement of an additional incision. Synovium procedures are rarely separately billed, with codes like 29875 (limited synovectomy) and 29876 (major synovectomy) used only in specific cases necessitating significant surgical procedures.<br /><br />For multiple ligament reconstructions, codes like 27405 (repair of torn ligament) and 27427 (ligamentous reconstruction) are applicable. For posterior cruciate ligament (PCL) reconstruction concurrent with ACL procedures, CPT 29889 is appropriate. In complex cases involving augmentation or separate ligament repairs, modifiers and detailed documentation in operative reports are essential to justify and differentiate the procedures.<br /><br />The focus is on selecting the correct CPT codes driven by medical necessity, with careful documentation to support the coding choices, especially for complex or combined procedures. Consulting with coding teams is recommended in case of uncertainties.

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Ryan Dopirak, M.D. & Patrick Joyner. M.D.

Keywords

ACL reconstruction

CPT 29888

meniscus surgery

chondral injuries

osteochondral autografts

loose body removal

synovectomy

ligament reconstruction

PCL reconstruction

medical necessity