Coding Challenges in Common Pediatric Sports Surgeries of the Knee

Abstract

Coding and billing for procedures is necessary but possibly the least enjoyable aspects of performing surgery. Additionally, proper documentation is crucial to support procedural coding and billing. Unfortunately, these are also areas in which orthopaedic surgeons receive the least consistent training, which can lead to enormous variability in how different surgeons code and bill for the same procedure. Pediatric sports medicine is a relatively younger subspecialty within pediatric orthopaedics and as such, techniques and approaches to surgery continue to evolve. As a result, many of the procedures performed may not have well established—or indeed any—corresponding CPT codes.
 This article presents case scenarios for common knee pathologies often treated surgically by pediatric orthopaedic surgeons. The intent is to clarify some discrepancies in coding for these procedures and aid the surgeon in proper billing. It is important to note that the following scenarios are hypothetical and therefore ultimate code selection should always reflect the operative report documentation.