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CODING ARTHROSCOPIC KNEE PROCEDURES

April 24th, 2013 - Deivakumar Chithirai
Categories:   Coding  
 
Knee Anatomy:
 
The medical compartment includes:
 
The lateral compartment includes:
The Patellofemoral compartment includes:
 
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:
 
 
 
 
 
 
 
 
 
Note: Don’t use the diagnostic code when a surgical knee arthroscopy is performed.
 
 
 
 
 
Note: Involves resection of synovium and/or plica from two or more compartment. The code 29876 can be assigned in addition to 29881
 
 
 
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.
 
 
 
 
 
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.
 
 
Note: This code is commonly assigned for debridement of “Cyclops lesion” which is localized arthrofibrosis which generally develops after ACL reconstruction.
 
 
 
An Arthroscopically aided ACL repair/reconstruction includes the following:
 
 
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.
 

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