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Orthopedic Coding Alert

Case Study:

Simple Guidelines Help Streamline Your Knee Arthroscopy Coding

" Not every plica excision and bursectomy will warrant separate codes

If you question yourself every time you code a knee surgery report, take a few minutes to brush up on your knee arthroscopy coding basics and you'll be on your way to cleaner claims.

Take a look at the following arthroscopic meniscectomy operative note, submitted by Linda Graham, coder at Nebel Orthopedic Center in Port Huron, Mich., and review our expert's coding recommendations.
Procedure Overview: Examine What the Surgeon Performed Here's a quick synopsis: Diagnostic arthroscopy revealed an anterior horn medial meniscus tear, hypertrophy of the medial and lateral patellar tendon bursae, symptomatic synovial plicae, chondromalacia patellar and chronic anterior cruciate ligament insufficiency.
The surgeon performed arthroscopic resection of the disrupted anterior horn of the medial meniscus, excision of the deep medial and deep lateral patellar tendon bursae, excision of the anterior lateral plica and the superior parapatellar plica strands, and a patellar chondrectomy. Operative Note: Trace the Surgeon's Work The pertinent details from the operative report follow: After diagnostic arthroscopy was completed, a 4/0 meniscal resector was introduced, and the anterior horn of the medial meniscus was excised. Next, on oscillate the deep lateral and medial patellar tendon bursae were excised.

The anterior lateral plica was excised, and this was a limited synovectomy and went up along the lateral aspect of the femoral condyle. Next, the instruments were passed into the patellofemoral joint region, and strands of parapatellar plica were excised, and a limited patellar chondrectomy of the medial patellar facet had moderate chondromalacia, grade 2.

Know Your Postoperative Diagnoses Anterior horn medial meniscus tear, right knee (836.0 or 717.1)
  Deep medial and lateral patellar tendon bursa hypertrophy and impingement, right knee (726.60) 
  Anterior lateral plica with impingement, right knee (727.83)
  Parapatellar plica with impingement, right knee (although this condition shares the same diagnosis code as the anterior lateral plica with impingement, you should report 727.83 only once on your claim)
  Chondromalacia of patella, right (717.7)
  Chronic anterior cruciate ligament tear, stable, right knee (717.83). Coding Advice: Follow These 3 Steps Step 1: Code the arthroscopic meniscectomy. First, report 29881-RT (Arthroscopy, knee, surgical; with meniscectomy [medial OR lateral, including any meniscal shaving]; Right side).

Watch out: Although the patient also had lateral tendon bursa hypertrophy and lateral plica with impingement, you cannot code a medial AND lateral meniscectomy"" (29880) because the surgeon only resected a medial meniscal tear - the patient did not have a lateral meniscus tear. " Step 2: Code the [...]

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