Coding Musculoskeletal System Procedures

Vol. 12 •Issue 12 • Page 8
Coding Corner

Coding Musculoskeletal System Procedures

Case Study

Preoperative Diagnosis: Degenerative tear of the medial meniscus, left knee.

Postoperative Diagnosis: Degenerative tear of the medial meniscus and chondromalacia of the patella and medial femoral condyle, left knee.

Procedure Performed: Arthroscopic partial medial meniscectomy, left knee.

Operative Technique: Under adequate spinal anesthesia and with the tourniquet on the left lower extremity, the left leg was scrubbed, prepped and draped sterilely. With the tourniquet up, a drainage needle was placed in the superior lateral pouch. The 30-degree arthroscope was introduced anterior medially and a probe anterior laterally.

Examination of the knee joint showed a few small floating cartilage fragments in the joint. There was considerable loss of articular cartilage on the lateral facet of the patella. Rough edges were smoothed with the Dyonics debrider, but the bone was not eburnated or exposed.

A plica in the pouch area as well as a very thick one in the medial gutter was resected with punch as well as Dyonics debrider. In the lateral compartment the meniscus was probed and found to be intact.

In the medial compartment there was a split tear with a radial tear as well in the posterior medial corner. This was debrided back to a stable rim using straight and side-cutting punches followed by the Dyonics debrider to further smooth out the remaining rim. The cartilage on the medial femoral condyle also was moderately damaged down to, but not exposing, the bone on the weight-bearing surface. This was also smoothed back with the debrider.

The wound was copiously irrigated with normal saline throughout the procedure and vacuumed of all debris. The arthroscopy was then discontinued, and the portals closed with staples. A sterile dressing was applied.

The patient tolerated the procedure well and returned to the recovery room in good condition.

Code Assignments and Rationale

ICD-9-CM Codes. The following diagnosis codes should be assigned for the above case study.

Preoperative: 717.3 Unspecified derangement of medial meniscus

Postoperative: 717.2 Derangement of posterior horn of medial meniscus

717.7 Chondromalacia of patella

733.92 Chondromalacia

CPT Codes. The surgeon states that a partial medial meniscectomy was performed arthroscopically. In the CPT code manual index, refer to the terms Arthroscopy, Surgical and Knee. After reading the code descriptions for the code range listed (29871Ð29889), you will see the correct code is 29881.

The surgeon also states that the articular cartilage of the patella and the medial femoral condyle were debrided. The patella is a different compartment than the medial femoral condyle or medial meniscus. The American Medical Association (AMA) states that the chondroplasty may be coded separately if performed in a separate compartment from the meniscectomy–in this case, the patella. Refer to the code descriptions in the Arthroscopy section (knee) of the index to find the appropriate code of 29877.

Assign modifier LT (left side of the body) to both of the facility CPT codes assigned. The excision of the plica is included. Add modifier 51, multiple procedures, to the second professional code.

Facility code assignments:

29881-LT Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving)

29877-LT Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)

Professional code assignments:

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

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

Brian Bonanno is a senior health care consultant with Medical Learning Inc. (MedLearn), St. Paul, MN.

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