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AHA Coding Clinic® for HCPCS - 2023 Issue 4; Ask the Editor

ACL Repair with Iliotibial (ITB) Tenodesis

A patient diagnosed with an anterior cruciate ligament (ACL) tear with risk factors for re-tear presents for definitive treatment. The quadriceps tendon was harvested; the femoral aspect measured 9.5 mm and the tibial aspect measured 10 mm. Both grafts were prepared for later use. Arthroscopic portals were utilized for complete knee examination identifying chondromalacia and a completely torn ACL. The femoral and tibial sockets were drilled and reamed (9.5 mm and 10 mm) in preparation for the passage of the grafts previously harvested. Next, the prepared quadriceps autograft was passed with a BTB tight rope on the femoral side. The femoral socket was approached first while passing the graft through the tibial tunnel and the button was provisionally tensioned on the femur. The tibial aspect of the quadriceps autograft was secured with an adjustable loop button was provisionally tensioned on the tibia. Intraoperative fluoroscopy confirmed successful deployment of the buttons. Final tensioning of the buttons was achieved and the tightrope and fiberlink sutures were tied over the buttons.Given the patient’s non-modifiable risk factors, we proceeded with an iliotibial band tenodesis. Next, 9 cm of the iliotibial band (ITB) was harvested through a lateral incision. The proximal end was amputated and the distal end remained intact. The lateral collateral ligament (LCL) was identified, an incision was made, and each side of LCL was identified anteroposterior.The previously harvested ITB graft was placed under the LCL. The ITB was anchored to the lateral epicondyle with a suture device. The remaining tissue was brought over the LCL and sutured to itself. The ITB tendon harvest site was closed.Would the iliotibial tenodesis and the iliotibial autograft harvest both be reported and what are the correct CPT codes? Would the ITB tenodesis and graft harvest be considered inherent to the ACL reconstruction? Does CPT code 27599 correctly represent the ITB tenodesis and graft? ...

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