Coding Knee Arthroscopies A Case Study

Coding Knee Arthroscopies A Case Study

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Coding Knee Arthroscopies: A Case Study

Peggy Hapner, CCS, RHIA

In the procedure described below, note that the chondroplasty was performed in a separate compartment. Because of this, a code can be assigned. Had the debridement been performed in the same compartment, a code could not be assigned.

Preoperative Diagnosis: Tear, lateral meniscus, right knee

Procedure Performed: Arthroscopic partial lateral meniscectomy, arthroscopic chondroplasty, patellofemoral joint

Indications for Procedure: The patient has had chronic pain anteriorly and laterally with catching. Magnetic resonance imaging (MRI) of the right knee documented a tear in the lateral meniscus.

Operative Findings: Athroscopic findings included horizontal tear extending from the anterior horn to the posterior horn in a parrot-beak tear with the base at the posterior horn. The chondral surface of the femoral trochlea was a full-thickness lesion distally. The inferior surface of the central patella revealed grade 2-3 chondromalacia. The anterior cruciate ligament was intact. The medial compartment was normal.

Operative Technique: Following satisfactory induction of local anesthesia supplemented by analgesia, the arthroscope was introduced through anterior inferior medial and lateral portals. A basket forceps and 4.5 synovator blade were used to debride the portions of the lateral meniscus tear. Basket forceps were used to debride the parrot-beak tear, and the fragment was excised in toto.

On #1 and #2 ablation level, the 2.5 cautery wand was used to smooth the margins of the chondral lesion. Copious lavage and irrigation was used throughout. The incisions were approximated with 5-0 Monocryl, and a dry sterile compressive bandage was applied.

Postoperative Diagnosis: Tear, lateral meniscus, parrot-beak type of the posterior third, with patellofemoral chondromalacia, right knee

ICD-9-CM Codes
Preoperative:

717.40 Derangement of lateral meniscus, unspecified

Postoperative:

717.43 Derangement of posterior horn of lateral

meniscus

717.7 Chondromalacia of patella

CPT Codes and Modifiers
To assign the correct code for the above procedure, check the CPT manual index under Arthroscopy, Surgical, Knee. Code range 29871­29889 is listed to the right of the Knee entry. To find the correct code, read each of descriptions. Be sure to assign modifiers when appropriate, as shown below.

For Facility Component
29881-RT Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) (-RT, Right side of body)

29877-RT Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty) (-RT, Right side of body)

For Professional Component
29881 Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving)

29877-51 Arthroscopy, knee, surgical; debridement/shaving of articular cartilage

Coding Tips
Read the operative report carefully to determine in what compartments the surgeon is working. When assigning a code for the meniscus, be sure you know whether the surgeon performed a meniscectomy on one or both of the menisci (medial, lateral), as this will determine the code assignment. In this case, the surgeon performed a lateral meniscectomy only, so the code assignment should reflect this.

Also determine in what compartment the chondroplasty is performed. If it is performed in the same compartment as the meniscectomy, do not code it separately as it is considered a bundled procedure (i.e., bundled into the meniscectomy procedure).

Since the chondroplasty for this patient was performed in a separate compartment, a separate CPT is appropriate. Again, check the index for the terms mentioned above, and review the descriptions in the code range. This will lead you to the correct code assignment of 29877.

Assign HCPCS Level II modifier -RT to both codes to report the facility component, as it was a right knee operation.

Peggy Hapner is a senior health care consultant and outpatient coding expert with Medical Learning Inc. (MedLearn^®), St. Paul, MN.