Is a Lateral Retinacular Release Separately Billable?

Question:

Our surgeon performed a reconstruction of a patella dislocation and also did an arthrotomy of the knee with a lateral retinacular release. Our surgeon wants to report 27420 and 27425. When I look at the NCCI edits, I see there is an edit between the two codes. Am I allowed to add a modifier 59 to CPT® code 27425 to indicate this is a distinct separate service?

Answer:

Thank you for your inquiry. Let’s start by taking a look at the CPT® code definitions.

27420 Reconstruction of dislocating patella; (eg, Hauser type procedure)27425 Lateral retinacular release, open

To answer, your Question:, the answer is “no, the lateral retinacular release is inclusive to CPT® code 27420 for the reconstruction of the patellar dislocation.

Why? Let’s take a look at the AAOS Global Service Data Guide for CPT® code 27420.

The following is an excerpt of procedures that are considered ‘inclusive” to CPT® code 27420 when performed during the same operative session.

• osteotomy (eg, 27457)
• arthrotomy of knee (eg, 27310, 27330, 27331)
• release of lateral retinaculum (eg, 27425)
• internal fixation
• chondroplasty of patella (eg, 27437)
• diagnostic arthroscopy of knee (eg, 29870)

You already note the NCCI edit between 27420 and 27425; adding modifier 59 to CPT® code 27425 represents incorrect coding.

*This response is based on the best information available as of 12/03/20.