By Margie Scalley Vaught, CPC, CPC-H, CCS-P, ASC-OR and ; M. Bradford Henley, MD; wilhelm R. Beach, MD; Blair C. Filler, MD; and Bernard A. Pfeifer, MD

With an ext than fifty percent (52 percent) of benidormclubdeportivo.org fellows who responded come the 2004 Orthopaedic Census reporting adult knee as a primary focus area in your practices, it’s no wonder that there are so many coding concerns on assorted knee procedures. This obelisk will attend to accurately coding anterior cruciate ligament (ACL) reconstructions, chondroplasties, miniscectomies and meniscal repairs. The next worry will include the five new CPT codes for 2005 and also minimally invasive/incision arthroplasty procedures.

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Knee Anatomy

According to the Centers for Medicare and also Medicaid solutions (CMS), the knee has actually three separate, distinct compartments. The medial and also lateral compartments make up the femoral-tibial articulation; the third compartment is the patellofemoral compartment. The benidormclubdeportivo.org has actually endorsed this division for coding purposes.

The medial compartment has the medial meniscus and the medial collateral ligament; the lateral compartment consists of the lateral meniscus and also lateral collateral ligament. The knee also contains the anterior and also posterior cruciate ligaments.

When reporting services, the first determinations need to be: what type of procedure to be performed, such together a repair, a reconstruction, a debridment, or one excision; and what an approach was used: open or arthroscopic.

Take treatment when reporting ICD-9 codes in enhancement to the CPT codes because that the operation procedure. Knee difficulties can it is in acute or chronic, and also there are specific ICD-9 password relating come the type of condition. Correct coding needs that particular ICD-9 codes have to be connected with the individual CPT codes for each knee procedure. Report the dorn ICD-9 code may mean you’ll have to answer questions later about the medical necessity the the procedure.

ACL reconstruction

The CPT password for an arthroscopic ACL restoration is 29888, “Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction.” follow to the benidormclubdeportivo.org global Service Data publication (GSD), this code covers: boy synovial resection for visualization; notchoplasty; ACL stump removal; partial synovectomy and also fat pad resection; intra-articular ligament reconstruction; harvesting and insertion the fascial, tendon or bone graft; diagnostic knee arthroscopy; inner fixation because that graft; arthroscopic lysis of adhesions; manipulation of the knee, and added or enlarging portals.

Excluded native an arthroscopic ACL restoration are: meniscectomy; meniscus repair; extra-articular augmentation, to exclude, of screw tenodesis of the illiotibial band; arthroscopic chondroplasty, separate compartment; arthroscopic abrasionplasty; and arthroscopic removed of loose bodies.

Some orthopaedic operated doctor have started using thermal treatments to “tighten” a extended ACL or to treat ACL laxity. CPT advises that it is not correct to pick a password that “merely approximates” the company being rendered and also specifies the the anatomically particular unlisted code need to be used. This way that password 29888 have to not be provided for thermal ACL procedures. The unlisted password 29999 have to be supplied instead.

Because there is additionally no password for a revision (re-do) arthroscopic ACL reconstruction, this procedure might be reported with either code 29999 (unlisted) or password 29888-22. An open revision ACL could likewise be reported with the unlisted code (29999) or by appending comprehensive –22 come the initial ACL code.

Harvesting and inserting the graft is contained in password 29888, nevertheless of whether the graft is a patellar tendon or a hamstring tendon. If, however, the tendon is derived from a distant site, such as the the contrary leg, you may report the harvest separately, utilizing the most suitable graft harvesting password (such as 2902X).

The rules for making use of the bone harvesting password (20900, 20902) and the codes for harvesting various other grafts are regularly misunderstood. This codes are only to it is in reported as soon as the graft is harvest from a “separate” site through a different skin or separate fascial incision, and also “when the graft is not already provided as component of the an easy procedure,” according to notes at the start of the Musculoskeletal device Section that the CPT Manual.

Some surgeons are now harvesting bone native the proximal tibia (e.g., indigenous the bone tunnel) and also grafting it come the patellar bone defect. This is taken into consideration a neighborhood bone graft, which is consisted of in the basic procedure, and should no be reported. Reporting this together a harvest and also transplant would be considered unbundling.

Meniscus repair

Meniscus repair has two arthroscopic codes and also one open code. Code 29882 is because that “arthroscopy, knee, surgical; through meniscus repair (medial OR lateral).” password 29883 is for “arthroscopy, knee, surgical; through meniscus fix (medial and also lateral).” The open up code, 27403, is because that “arthrotomy v meniscus repair, knee.”

Because the open up code walk not resolve the worry of compartments, there is part question about whether it covers both medial and also lateral menisci or whether it can be reported twice. The CPT hand-operated refers coders to the arthroscopic code 29882, which seems to indicate that the open up code 27403 is because that medial OR lateral, and also thus can be reported twice. However, carriers have the right to have their own interpretations.

According come the benidormclubdeportivo.org Coding, Coverage and also Reimbursement Committee, a surgeon who performs a medial and also a lateral meniscus repair making use of open technique should report codes 27403 and 27403-59 (or -51, relying on carrier issues) to suggest two different compartments were addressed. This is in line v both the family member value units and the recognized three compartments.

benidormclubdeportivo.org has actually requested that CMS clarify the listing a password for one compartment the the knee need to not and will not impact coding because that the other compartments. A readjust in the parenthetical notes showing this should show up in the 2006 edition of the CPT Manual.

According come the benidormclubdeportivo.org GSD, password 27403 includes: synovial biopsy; expedition of joint; resection that plica (partial or total); partial synovectomy; diagnostic arthroscopy; manipulation of the knee, and partial meniscectomy.

The benidormclubdeportivo.org GSD states that the arthrsocopic codes 29882 and 29883 include: plica/synovial resection; debridement/shaving of the meniscus; meniscal tissue removal (same meniscus); diagnostic arthroscopy; lavage and drainage; manipulation that the knee, and also lysis of adhesions. Code 29882 does no include: meniscectomy that the various other meniscus; remove of loosened bodies (nonmeniscal) bigger than 5 mm and/or v a separate incision.

Synovectomy

CPT has actually two codes for synovectomy: 29875 because that one compartment and 29876 for two or much more compartments. However, this can be misleading.

Consider this example: A patient has a medial meniscectomy (29881) together with both medial and also lateral synovectomies. Back this is technically a two-compartment synovectomy, the medial synovectomy is consisted of in the code for the medial meniscectomy. Therefore, just a solitary compartment synovectomy (29875) have the right to be reported.

Chondroplasty

The code for chondroplasty (29877) has caused much confusion, which is currently aggravated by the enhancement of a Medicare HCPSC Level II code (G0289). Component of the man stems from the misreporting of the ideal ICD-9 code. Chondromalacia that the patella is reported with ICD-9 password 717.7. However, chondromalacia the the medial or lateral knee need to be reported through ICD-9 code 733.92.

The advent of code G0289 for Medicare patient invalidates the use of CPT password 29877 as soon as the chondroplasty is performed with another arthroscopic knee procedure. This walk not typical that you can not report a concomitant knee chondroplasty perform in a various compartment. However, it does mean that you should report the G0289 through the other procedures.

Here are some examples: you would certainly report 29881 and G0289 for a Medicare patience who has actually a medial meniscectomy and also a lateral chonroplasty. If simply chondroplasties space performed in both the medial and also lateral compartments, you would report code 29877. A medial meniscectomy through chondroplasties in both the lateral and patellofemoral compartments would be reported v 29881, G0289 and also G0289-59. (Remember the modifiers deserve to be carrier-driven issues.)

It can be a little trickier because that non-Medicare patients. Many third-party carriers room adopting the G code and also requiring its usage (instead the 29877) in report chondroplasties perform concurrent with various other arthroscopic knee procedures. Carrier should recognize that the G code can be reported much more than once, detailed each point out is because that a separate compartment. However, code 29877 deserve to be reported just once, nevertheless of how plenty of compartments room affected.

Whether you usage 29877 or G0289, you must have actually adequate documentation. In Medicare guidance published in the Nov. 7, 2002, federal Register, “this add-on code is offered only when the procedure perform is a substantive procedure required to produce a far-ranging improvement in the patient’s condition. Documentation supporting this must be reflect in the operative notes.”

Your documentation demands to describe what girlfriend found, how you perform the chondroplasty and also whether it solved the patient’s problem. A chondroplasty have the right to be reported in addition to other arthroscopic procedures if that is sustained by documentation.

Abrasion arthroplasty

benidormclubdeportivo.org guidelines allow reporting that abrasion arthroplasty if the documentation supports that debridement was performed under to “bleeding bone.” Abrasion arthroplasty is not restricted by compartments and can be reported double if carry out in both the medial and lateral compartments (as 29879 and 29879-59 or -51, depending upon carrier issues).

Many offices are report an abrasion arthroplasty (29879) once the documentation support a chondroplasty (29877). Reporting a chondroplasty together an abrasion arthroplasty is thought about “upcoding” and should not be done.

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According to the benidormclubdeportivo.org GSD, password 29879 covers: synovial resection because that visualization; remove of osteochondral and/or chondral bodies (attached); diagnostic arthroscopy; chondroplasty; lavage and also drainage; lysis the adhesions, and manipulation that the knee. That does not include arthroscopic meniscectomy and/or repair or arthroscopic removed of loose bodies or international bodies 5 mm or better and/or v a different incision.

According to the august 2001 CPT Assistant, “When smoothing down the cartilage and/or drilling feet to develop microfractures, code 29879 may be reported. Abrasion arthroplasty is usually performed to promote cartilage regeneration by creating access to blood and nutrients by smoothing under the cartilage and/or drilling feet to create microfractures. Password 29879 consists of chondroplasty carry out as component of the abrasion arthroplasty, so password 29877 need to not be individually reported. If, however, chondroplasty is perform in a different knee compartment, password 29877 might be reported separately. Comprehensive -59, distinctive Procedural Service, should be appended to indicate that a separate compartment was involved.”

Margie Scalley Vaught, CPC, CCS-P, CPC-H, ACS-OR, is an elevation coding specialist in Ellensburg, Wash., a bones member and also a past member of the national Advisory Board, American Academy of skilled Coders. She deserve to be got to at vaught