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Coding for Hospitalists


General

Author:
Deivakumar Chithirai
CODING ARTHROSCOPIC KNEE PROCEDURES
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Knee Anatomy:
 
The medical compartment includes:
  • Medial Femoral condyle
  • Medial tibial plateau
  • Medial meniscus
 
The lateral compartment includes:
  • Lateral Femoral condyle
  • Lateral tibial plateau
  • Lateral meniscus
The Patellofemoral compartment includes:
  • Patella
  • Patellofemoral joint
  • Intercondylar notch of the femur
  • Suprapatellar pouch
  • Trochlea
 
Arthroscopy:
 
Knee arthroscopy allows the physician to visualize the joint space of the knee using a fiberoptic endoscope. (An endoscope is basically a long tube with a lens at each end. Endoscopes used to visualize joint spaces are call arthroscopes).
This Technology also allows the physician to perform arthroscopic surgery using
Instruments inserted through small incisions, instead of having to perform an open
procedure.
 
Arthroscopic knee surgery usually involved at least two incisions. The first incision is made on the lateral side of the patellar incision-this is where the arthroscope is inserted. Additional incisions are made, one on the medial side of the patellar tendon and other as needed, for the insertion of surgical instruments. These incisions are called portals. Saline is infused into the joint space to expand the cavity for easier viewing and instrumentation. The surgeon thoroughly examines the joint first; this may require repositioning the leg in order to access all the recesses of the joint cavity. After the diagnostic examination, any problems noted may be corrected arthroscopically.
 
When both a diagnostic and surgical arthroscopy is performed, the diagnostic arthroscopy is an inclusive component of the surgical arthroscopy and would not be reported separately. (CPT® Assistant August 2001; page 5)
 
Arthroscopic procedures in Separate Compartments:
 
When both a diagnostic and surgical arthroscopy is performed, the diagnostic arthroscopy is an inclusive component of the surgical arthroscopy and would not be reported separately. (CPT® Assistant August 2001; page 5)
 
From a CPT® coding perspective, if debridement or shaving of articular cartilage and meniscectomy are performed in the same compartment of the knee, then only code 29881, Arthroscopy, knee, surgical; with meniscectomy (medial or lateral, including any meniscal shaving), should be reported. However, if debridement or shaving of articular cartilage is performed in one compartment of the knee and a meniscectomy is performed in a different compartment of the knee, then codes 29877, Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty), and 29881 should be reported. (CPT® Assistant April 2005; page 14)
 
An important HCPCS code is G0289, Arthroscopy, knee, surgical, for removal of loose body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee. This code is used for Medicare patient’s to report the procedure in that description, when performed in a separate compartment of the knee during the same operative session. It is not appropriate to use code 29877 even with at modifier.
 
HCPCS code G0289 may be reported in addition to CPT® code 29880, Arthroscopy, knee, surgical; with meniscectomy (media AND lateral, including any meniscal shaving) or CPT® code 29881, Arthroscopy, knee, surgical; with meniscectomy (medial or lateral, including any meniscal shaving)if performed in a separate compartment.
 
For Example:
An arthroscopy with a medial meniscectomy and shaving of the articular cartilage in the lateral compartment is performed on the left knee, commercial carrier.
 
            29881-LT – identifies the excision of the meniscus
            29877-LT-59 – identifies debridement/shaving of the cartilage
 
An arthroscopy with a medial meniscectomy and shaving of the articular cartilage in the lateral compartment is performed on the left knee, Medicare patient.
 
            29881-LT – identifies the excision of the meniscus
            G0289-LT– identifies debridement/shaving of the cartilage
 
When appropriate use the -59 modifier with the second procedure. This will let the
Insurance company know that the procedures listed were performed in separate
Compartments of the knee.
 
An arthroscopy for medial meniscal repair with at Patellofemoral chondroplasty
            29882 – Arthroscopic meniscal repair
            29887-59 – arthroscopic Patellofemoral chondroplasty
 
If an arthroscopic procedure is performed at one site and an open procedure is performed at a different site, a modifier should be used to indicate this (-59, RT, LT, etc.). When a procedure is started arthroscopically and converted to an open procedure, only the most comprehensive service is billed. Exception for this rule, if the physician performs a therapeutic procedure through the scope but had planned to do another procedure open, then both procedures may be billed pending verification with the appropriate guidelines.
 
 
 
Common Arthroscopic Knee Procedures:
 
  • 29850 - Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation; without internal or external fixation (includes arthroscopy)
 
  • 29851 - Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation; with internal or external fixation (includes arthroscopy)
 
  • 29855 - Arthroscopically aided treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed (includes arthroscopy)
 
  • 29856 - Arthroscopically aided treatment of tibial fracture, proximal (plateau); bicondylar, includes internal fixation, when performed (includes arthroscopy)
 
  • 29866 - Arthroscopy, knee, surgical; osteochondral autograft(s) (e.g., mosaicplasty) (includes harvesting of the autograft[s])
 
  • 29867 - Arthroscopy, knee, surgical; osteochondral allograft (e.g., mosaicplasty)
 
  • 29868 - Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateral
 
  • 29870 - Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)
 
Note: Don’t use the diagnostic code when a surgical knee arthroscopy is performed.
 
  • 29873 - Arthroscopy, knee, surgical; with lateral release
 
  • 29874 - Arthroscopy, knee, surgical; for removal of loose body or foreign body (e.g., osteochondritis dissecans fragmentation, chondral fragmentation)
 
  • 29875 - Arthroscopy, knee, surgical; synovectomy, limited (e.g., plica or shelf resection) (separate procedure)
  • Note: Involves resection of synovium and/or resection of plica from one compartment.
 
  • 29876 - Arthroscopy, knee, surgical; synovectomy, major, two or more compartments (e.g., medial or lateral)
 
Note: Involves resection of synovium and/or plica from two or more compartment. The code 29876 can be assigned in addition to 29881
 
  • 29877 - Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)
 
  • 29879 - Arthroscopy, knee, surgical; abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture
 
Note: This includes chondroplasty where necessary. This procedure promotes cartilage regeneration by creating access to bone and/or drilling holes to create microfractures. The code 29879 can be assigned in addition to 29881.
 
  • 29880 - Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving)
 
  • 29881 - Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving)
 
  • 29882 - Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral)
 
  • 29883 - Arthroscopy, knee, surgical; with meniscus repair (medial AND lateral)
 
Note: Some times a physician may indicate he did a meniscus repair when he really meant a meniscectomy. The operative report may include some description of sutures or “arrows” into the meniscus if a repair was performed.
 
  • 29884 - Arthroscopy, knee, surgical; with lysis of adhesions, with or without manipulation (separate procedure)
 
Note: This code is commonly assigned for debridement of “Cyclops lesion” which is localized arthrofibrosis which generally develops after ACL reconstruction.
 
  • 29888 - Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction
 
  • 29889 - Arthroscopically aided posterior cruciate ligament repair/augmentation or reconstruction
 
An Arthroscopically aided ACL repair/reconstruction includes the following:
 
  • Insertion of synthetic bone substitute bone matrix/methylmethacrylate
  • Internal fixation of graft
  • Notchplasty
  • Insertion or placement of surgical drain
  • Closure of wound and repair of tissues for initial surgical exposure. Only complicated wound closures and those requiring flaps or grafts may be separately billed
  • Harvesting of the graft (fascia, tendon or bone) even if performed through a separate incision
 
Unlisted Procedure, Arthroscopy
 
There are some arthroscopic procedures that do not have specific CPT® code assignments. In those cases, the unlisted procedure code would be assigned. Here are some examples of procedures coded to 29999.
 
  • Meniscus Trephination: Drilling multiple holes in the torn part of the meniscus and/or joint capsule to promote healing.
  • Anterior cruciate ligament debridement: Debridement of fraying or tears of the ligament
  • Notchplasty: Used to widen the anterior portion and recess of the roof of intercondylar notch typically involving removal of 3-5 mm of bone from the lateral femoral condyle.
  • Bursectomy: Removal of the bursa for pathology not associated with another procedure. Bursectomy done for better visualization of the knee joint during arthroscopic surgery is consider inclusive of the procedure.
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