Coding guidelines for soft tissue knee procedures based on a national Delphi consensus study

• Published in: SA Orthopaedic Journal Vol. 22; no. 4; pp. 178 - 184
• Main Authors: Held, Michael, North, David, Hardcastle, Peter, Erasmus, Peter, Firer, Ponky, Gelbart, Bradley, Barrow, Michael, Von Bormann, Richard, Dunn, Robert
• Format: Journal Article
• Language: English
• Published: Johannesburg Medpharm Publications 01.11.2023
• Subjects: Health Care Sciences & Services; Level 4; Ligaments; Orthopedics; coding; South Africa; arthroscopy; soft tissue knee procedures; billing
• ISSN: 2309-8309; 1681-150X; 1681-150X; 2309-8309
• DOI: 10.17159/2309-8309/2023/v22n4a2

\r\nBackground\r\nNo guidelines for ethical coding practice of commonly performed soft tissue knee procedures exist in South Africa. The aim of our study was to establish and prioritise codes for these procedures via a consensus of knee surgeons.\r\n\r\nMethods\r\nFifty-nine South African Knee Society (SAKS) members were approached for a blinded Delphi consensus process. In the first survey round, a list of codes was generated which was prioritised in subsequent rounds. Agreement of 70% or more was defined as consensus. These codes were then moderated during a fourth round by the SAKS committee.\r\n\r\nResults\r\nSixteen SAKS members, performing a median of 200 knee procedures (interquartile range [IQR] 115–312) annually, participated in each round. Consensus was achieved for codes 0667, 0614 and 0673 when coding for meniscus and cartilage surgery. For anterior cruciate ligament reconstruction 0667, 0614, 0679, 0673 and 0775 all reached consensus. Here, some codes (0593) did not achieve consensus although their inclusion was promoted by the SAKS committee round. Furthermore, 88% of the participants agreed that rule 0005 should be used for multiple knee ligament reconstruction, and each should be seen as a separate procedure. Code 0592 (36%) should not be routinely used for minor debridement. No code exists to code for increased complexity in meniscal root repairs and therefore 0677 was proposed to be reassigned for meniscus repair, as well as 0296 to code for the major technical nature of the procedure. For medial patellofemoral ligament reconstructions, 0679 (88%) and 0579 (63%) were proposed along with 0667 (100%), 0775 (94%) and 0614 (69%). For osteotomy of the knee region, codes 0527 (94%) and modifier 0051 were put forth, as well as 0667 (75%), 0614 (75%) and 0673 (56%). When bone is harvested and/or grafted, 0507 (56%) and 0499 (44%) respectively are also thought to be appropriate.\r\n\r\nConclusion\r\nThis consensus study is based on the coding practice of 16 members of the South African Knee Society performing a median of 200 knee procedures annually. A variety of techniques are available, some without specific allocated codes which called for moderation and reallocation of certain codes. With this work we hope to achieve transparent and consistent coding for soft tissue knee procedures.