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Orthopedic Coding Alert

Get a Leg Up on Coding for Knee Arthroscopy

Find the answers to top-5 questions

Knee arthroscopy is a surgical technique whereby the surgeon inserts a tube-like instrument into a joint to inspect, diagnose and repair tissues. Arthroscopic surgery on the knee involves inserting a small camera (less than 1/4 inch diameter) into the knee joint through a small incision (barely larger than the camera).

This camera is attached to a video monitor that the surgeon uses to see inside the knee. For a simple surgical procedure, a local or regional anesthetic is administered, which numbs the affected area, but the patient remains awake and able to respond. For more extensive surgery, general anesthesia may be used.

After the physician inserts the camera, he pumps in saline under pressure to expand the joint and to help control bleeding. Some surgeons also use a tourniquet to prevent bleeding, but this can obscure the picture on the monitor. After looking around the entire knee for problem areas, the surgeon usually makes one to four additional small incisions to insert other instruments.

Commonly used instruments include a blunt hook to pull on various tissues, a shaver to remove damaged or unwanted soft tissues, and a burr to remove bone. At the completion of the surgery, the physician drains the saline, closes the incisions, and applies a dressing. 

Background: The knee joint is the largest joint in the body. Anatomists and orthopedists usually describe it as having three compartments. A common term in an orthopedist's chart is a patient described as having -tri-compartmental osteoarthritis,- meaning that all three compartments are involved with arthritic change. The three compartments are the medial compartment, the lateral compartment and the patello-femoral compartment.

The medial and lateral compartments are described more accurately as the medial femoral-tibial compartment and the lateral femoral-tibial compartment, respectively.

The knee includes another anatomic region, termed the intra-articular notch. This is the open posterior area of the femur between the medial and lateral femoral condyles. It is often operated upon because it contains the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL), but it is really not considered a -compartment- for coding purposes.

Want to know what you can bill with your arthroscopy claims? Here are five pressing knee coding questions and expert answers on how to code them. Bypass Limited Synovectomy Bundles Question 1: When the surgeon performs separate compartment synovectomy with meniscectomy, which code combination should we report?

Answer: You have two coding choices when your surgeon performs synovectomies: 29875 and 29876. The National Correct Coding Initiative (NCCI) bundles [...]

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