Coding Knee Arthroscopies Can Be Tricky

Knee arthroscopy is one of the most common orthopedic procedures in the US. Approximately 1.5 million knee arthroscopies are performed in the U.S. each year, mainly due to the many advantages over an open procedure, such as no large incisions into the knee; can be performed on an outpatient basis; less painful; and shorter recovery time.

When performing a knee arthroscopy a small incision is made in the skin and an arthroscope, which contains a small camera and light system to magnify and illuminate the joint structure, is inserted into the knee. Fluid is then injected into the joint to distend it and provide better visualization of the structures within the knee. The camera allows the physician to examine the entire knee joint to determine the type of injury or condition, then proceed to correct or repair the abnormality identified.

Knee endoscopies are performed for both diagnostic and therapeutic purposes. A diagnostic arthroscopy may be performed to examine and diagnose abnormalities in the knee joint. A surgical arthroscopy may be performed to treat diseased or damaged structures of the knee joint, such as a torn meniscus, damaged patella and inflamed or damaged synovium.

Knee Arthroscopy Coding
CPT codes 29866 through 29887 are used to report a knee arthroscopy. HCPCS code G0289, Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee, is also used in some instances for Medicare claims.

Refer to the following table or the CPT Book for a full description of the entire list of knee arthroscopy codes.

Coding knee arthroscopies can be a challenge to coders especially when performing multiple procedures or when procedures are performed on multiple compartments of the same knee. The knee is divided into three compartments; medial, lateral and patello-femoral. When coding knee arthroscopies it is important to read the operative report carefully to identify whether or not procedures were performed on one or more compartments of the knee joint.

When both a diagnostic and surgical arthroscopy are performed, the diagnostic arthroscopy (29870) is an inclusive component of the surgical arthroscopy and would not be reported separately.

When multiple surgical procedures are performed in the same compartment of the knee, only the most complex procedure is reported.

Example: Both a meniscectomy (29881) and debridement of loose cartilage (29877) are performed in the medial compartment of the right knee. Only code 29881 should be reported.

Procedures performed in a different compartment of the same knee should be coded with the modifier -59 appended.

Example: A meniscectomy is performed in the medial compartment and a major synovectomy is performed in the medial and lateral compartments of the same knee. Code 29881 would be reported for the meniscectomy in addition to 29876 for the synovectomy. Modifier 59 is appended to code 29876 to identify it as a distinct procedure performed in a different compartment.

It is important to note that Medicare will not allow the reporting of CPT codes 29874 and 29877 with other arthroscopic procedures performed on the same knee. When debridement/shaving of articular cartilage (chondroplasty) (29877), or removal of loose body or foreign body (29874) are performed at the same time as another surgical knee arthroscopy in a different compartment of the same knee, code G0289 should be reported instead of codes 29874 and 29877. G0289 is only to be reported once per extra compartment, even if debridement and loose or foreign body removal are all performed. The code may be reported twice if the physician performs these procedures in two compartments in addition to the compartment where the main procedure was performed. This code should be reported only when the physician spends at least 15 minutes in the additional compartment performing the procedure.

Example: An arthroscopic meniscectomy is performed in the medial compartment and shaving of the articular cartilage is performed in the lateral compartment. Codes 29881 and G0289 would be assigned.

If there is no CPT code to identify the arthroscopic procedure performed then code 29999, unlisted procedure, arthroscopy, should be assigned. When using the unlisted code be sure to submit supporting documentation with the claim to provide a clear description of the extent and nature of the procedure, as well as the amount of time and equipment required to provide the service.

For more information on the assignment of knee arthroscopy codes refer to CPT Assistant, December 2005, April 2005, September, 2004, December 2003, April 2003, August 2001 and June 1999.

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Test your knowledge on knee arthroscopy coding with the following quiz:

1. A patient undergoes a left arthroscopic medial meniscal transplant, which requires the remnant of the meniscus be removed. What is the correct CPT code assignment?

a. 29881

b. 29882

c. 29881 and 29868

d. 29868

2. A diagnostic arthroscopy of the knee was performed. During the procedure the physician repaired a torn medial meniscus and removed some debris from the same compartment. What is the correct CPT code assignment?

a. 29870, 29881, 29874

b. 29881

c. 29881, 29874

d. 29881, G0289

This month’s column has been prepared by Cheryl D’Amato, RHIT, CCS, director of HIM, facility solutions, Ingenix, and Melinda Stegman, MBA, CCS, clinical technical editor, Ingenix (www.ingenix.com).

CPT is a registered trademark of the American Medical Association.

Answers:
1. d: Assign only code 29868, Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateral. Meniscectomy (29881) and meniscus repair (29882) are inclusive when performed in the same compartment and should not be reported separately.

2. b: Assign only code 29881, Arthroscopy, knee, surgical; with meniscectomy. Code 29870 is not assigned because a diagnostic arthroscopy is not coded if a surgical arthroscopy is also performed. When multiple surgical procedures are performed in the same compartment of the knee; only the most complex procedure is reported. In this instance the meniscectomy is the most complex procedure performed.