ACL Reconstruction

CPT 29888 · 13.94 wRVU · 90-day global
CPT29888
wRVU13.94
Global90-day
ApproachArthroscopic
ComplexityComplex
Add-on / Variant CPTs
  • 29881 wRVU: 6.85 — Meniscectomy, medial OR lateral (6.85 wRVU, 90-day global) — bill with 29888 when performed; requires modifier 59/XS to bypass NCCI edit; chondroplasty (29877) is bundled into 29881 per CPT descriptor and cannot be separately billed
  • 29880 wRVU: 7.21 — Meniscectomy, medial AND lateral (7.21 wRVU, 90-day global) — use when both compartments debrided; modifier 59/XS required with 29888
  • 29882 wRVU: 9.36 — Meniscus repair, medial OR lateral (9.36 wRVU, 90-day global) — modifier 59/XS required with 29888
  • 29883 wRVU: 11.48 — Meniscus repair, medial AND lateral (11.48 wRVU, 90-day global) — use when both menisci repaired; modifier 59/XS required with 29888
Preoperative Diagnosis:

Right [left] anterior cruciate ligament tear, [acute / chronic], confirmed on MRI

Postoperative Diagnosis:

Same

Procedure Performed:

Right [left] arthroscopic ACL reconstruction with [bone-patellar tendon-bone / hamstring (gracilis/semitendinosus) / quadriceps tendon] autograft

Attending Surgeon:

[Attending name], MD/DO

First Assistant:

[Resident/PA name]

Anesthesia:

General endotracheal [/ spinal] with adductor canal block

Indications:

The patient is a [age]-year-old [male/female] who sustained a right [left] ACL tear [X months] ago. The patient presents with [instability / giving way / inability to return to sport] and desires surgical reconstruction. MRI confirmed complete ACL disruption [with associated meniscal / chondral pathology]. The risks, benefits, and alternatives including conservative management were discussed and informed consent was obtained.

Findings:

Arthroscopic examination confirmed complete ACL disruption. The [medial / lateral] meniscus was [intact / had a [posterior horn / bucket-handle] tear requiring [repair / partial meniscectomy]]. Articular cartilage was [intact / had Grade [I–IV] chondral injury at the [medial femoral condyle / lateral femoral condyle / trochlea]]. The PCL and collateral ligaments were intact. Graft: [BPTB / hamstring] autograft, [X] mm diameter.

Description of Procedure:

The patient was positioned supine with the operative knee in a leg holder. A thigh tourniquet was applied. Standard anteromedial and anterolateral arthroscopic portals were established. A diagnostic arthroscopy was performed.

[GRAFT HARVEST: BPTB]
A [3]-cm anterior longitudinal incision was made overlying the patellar tendon. The central third ([10] mm) of the patellar tendon was harvested with [25] × [10]-mm bone plugs from the patella and tibial tubercle. The harvest defect was filled with bone graft. The graft was prepared on the back table to [X] mm diameter.

[GRAFT HARVEST: HAMSTRING]
The gracilis and semitendinosus tendons were harvested through a [3]-cm anteromedial tibial incision using a closed tendon stripper. The tendons were prepared as a [quadrupled] graft to [X] mm diameter.

Notch preparation and debridement were performed. The ACL tibial guide was set to [55°] and the tibial tunnel was drilled at the anatomic ACL tibial footprint. The femoral tunnel was drilled [via accessory medial portal / transtibially] at the anatomic femoral footprint [9:30 / 2:30 o'clock position (anatomic footprint — not the isometric 10:30/1:30 position)], to a depth of [30] mm.

The graft was passed through the tibial tunnel and into the femoral tunnel. [Femoral fixation: [Endobutton / interference screw] at [X°] of knee flexion.] The graft was tensioned at [20–30 lbs]. [Tibial fixation: [X]-mm × [X]-mm interference screw with the knee at [10–20°] flexion.] Final arthroscopic inspection confirmed anatomic graft position and full range of motion without impingement.

[Concomitant meniscal repair / partial meniscectomy was performed as described.]

Portals were closed with [3-0 Monocryl]. A sterile dressing and knee immobilizer were applied.

Complications:

None

Specimens:

None

Estimated Blood Loss:

Minimal

Drains:

None

Disposition:

The patient was taken to the PACU in stable condition. Weight-bearing as tolerated with crutches was permitted. A postoperative rehabilitation protocol was provided. Follow-up in [2 weeks].

Epic SmartPhrase Version 
PREOPERATIVE DIAGNOSIS: Right/Left ACL tear, ***
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Right/Left ACL reconstruction, *** autograft
ATTENDING: ***, MD/DO
ASSISTANT: ***
ANESTHESIA: General + adductor canal block

INDICATIONS: .PTAGE-year-old .PTSEX with ACL tear *** months, instability. MRI confirmed. Consent obtained.

FINDINGS: ACL completely disrupted. Menisci: ***. Cartilage: ***. PCL/collaterals intact. Graft: *** autograft *** mm.

PROCEDURE:
Supine, leg holder. Tourniquet. AM/AL portals. Diagnostic scope: findings above. Graft harvest: ***. Graft *** mm prepared. Notch debridement. Tibial tunnel at 55°, anatomic footprint. Femoral tunnel via ***, 9:30/2:30 (anatomic), 30 mm. Graft passed. Femoral fixation ***. Tensioned. Tibial fixation *** × *** mm interference screw. Scope confirmed anatomic position, full ROM, no impingement. [Meniscal ***]. Closed.

EBL: Minimal
COMPLICATIONS: None
DISPOSITION: WBAT with crutches. Rehab protocol provided.

Signed: .ME, .MYDEGREE
.TODAY
Variants

ACL Reconstruction: Allograft

Given [patient age > 40 / prior harvest site morbidity / revision ACL surgery / patient preference], an allograft was selected. A [BPTB / Achilles / anterior tibialis] allograft processed by [tissue bank] was used. The graft was thawed and prepared to [X] mm. Fixation proceeded as described. Allografts have higher re-tear rates in young active patients and slower biological incorporation; they are preferred in older or lower-demand patients to avoid donor site morbidity. In revision ACL, autograft (contralateral BPTB or quadriceps tendon) is preferred when a virgin harvest site is available — MARS data show allograft carries approximately 4x higher re-tear risk in revision settings. Allograft is considered in revision only when prior autograft sites are exhausted.

Lateral Extra-Articular Tenodesis (LET): Augmentation

Given [high-grade pivot shift / revision ACL / anterolateral ligament injury / young athlete returning to pivoting sport], lateral extra-articular tenodesis was performed to augment rotational stability. The iliotibial band was harvested as a [modified Lemaire / MacIntosh] strip, left attached distally, and tunneled under the fibular collateral ligament to a bone tunnel in the lateral femoral condyle. The graft was tensioned at 30° flexion with the knee in neutral rotation and fixed with a [6.5-mm] screw. LET reduces the pivot-shift and reduces graft rupture rates in high-risk patients (STABILITY trial: 11% vs 4.5% failure, ACLR alone vs ACLR+LET); a statistically significant improvement in return-to-sport rate as an independent endpoint was not demonstrated.

Charting Tips
  • Document graft diameter. ACL graft diameter <8 mm (hamstring) is associated with significantly higher re-tear rates. Document the measured graft size and if the diameter was suboptimal, document the decision rationale.
  • Document tunnel positions using anatomic landmarks (footprint, clock face). 'Isometric' tunnel placement is no longer the standard; anatomic placement at the native ACL footprint is. Documentation of the anatomic position justifies the technique and defends against claims of nonanatomic reconstruction if the patient re-tears.
  • Document concomitant meniscal pathology and treatment. Untreated meniscal tears at the time of ACL reconstruction accelerate articular cartilage degeneration. Document what was found, what was done, and why (repair vs. resection).
  • Document exam under anesthesia (Lachman, anterior drawer, pivot-shift) before preparing the operative field — confirms diagnosis, documents instability grade, and is expected by auditors. Document tourniquet inflation time (medicolegal standard).
Billing Tips
  • Arthroscopic ACL reconstruction uses 29888 (13.94 wRVU, 90-day global). CPT 27407 (10.58 wRVU) is for open primary cruciate ligament repair (ACL or PCL) — not arthroscopic reconstruction. CPT 27409 (13.37 wRVU) is for primary repair of both cruciate AND collateral ligaments (multi-ligament injury — replaces 27407, not billed alongside it).
  • Concomitant meniscectomy (29881 medial/lateral, 29880 both; 6.85/7.21 wRVU) and meniscus repair (29882 medial/lateral, 29883 both; 9.36/11.48 wRVU) are separately reportable with 29888 — but require modifier 59 or XS to bypass NCCI edits. Document each compartment addressed. Chondroplasty (29877, 8.09 wRVU) is always bundled into 29881/29880 per CPT descriptor and cannot be separately billed in the same compartment. For Medicare patients, chondroplasty in a separate compartment from a meniscal procedure uses HCPCS G0289 (not 29877).
  • Graft type (patellar tendon, hamstring, quadriceps tendon, allograft) does not change the CPT code — all bill as 29888. Allograft material may be billed separately as a facility supply.
  • 90-day global period: physical therapy coordination, brace management, and routine follow-up are bundled. Formal PT sessions are billed by the therapist independently.

General coding reference. Verify with your institution’s billing department before submitting claims.

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