Q&A: CPT coding for a subchondroplasty procedure
Q: What is a subchondroplasty and how is this procedure reported in CPT?
A: “Subchondroplasty” is a marketing tradename and is not recognized as a standard procedure. The term refers to a procedure performed by orthopedic surgeons to fill subchondral bone defects through the injection of bone substitute material. Many insurance companies consider this procedure experimental or investigational.
Often, a physician will decide to perform a subchondroplasty during arthroscopic joint surgery to treat subchondral bone defects (microfractures).
If the patient is scheduled for a subchondroplasty, the physician may perform an arthroscopy at the same time to aid in visualization of the affected area. The physician may also use a scope after the procedure is completed to remove extraneous cement.
No official coding guidance has been released on appropriate CPT coding for this procedure. According to Zimmer Biomet Holdings Inc., the orthopedic medical device company with a patent on the subchondroplasty procedure, outpatient facilities may use the following CPT codes to report it:
- 23929, unlisted procedure, shoulder
- 27299, unlisted procedure, pelvis or hip joint
- 27599, unlisted procedure, femur or knee
- 27899, unlisted procedure, leg or ankle
- 28899, unlisted procedure, foot or toes
- 29999, unlisted procedure, arthroscopy
Additional guidance from Zimmer Biomet, including CPT coding considerations for physicians, is available here.
Editor’s note: This question was answered by Lynn Anderanin CPC, CPMA, CPPM, CPC-I, COSC, senior director of coding education at Healthcare Information Services in Park Ridge, Illinois, during the HCPro webinar, “Unpack ICD-10-CM and CPT Coding for Major Joint Arthroscopies and Total Joint Replacements.”
This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.