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Orthopedic Coding Alert

Knee Coders' Toolkit:

Revealed - Answers to Top-5 Knee Coding Questions

 Want to know what you can bill with your arthroscopy claims? Look no further We've compiled five of our subscribers' most pressing knee coding questions and asked our experts how to code them. Read on to firm up your knee coding knowledge. Bypass Limited Synovectomy Bundles Question 1: When the surgeons perform separate compartment synovectomy with meniscectomy, which code combination should we report?

Answer: You have two coding choices when your surgeon performs synovectomies: 29875 (Arthroscopy, knee, surgical; synovectomy, limited [separate procedure]) and 29876  (... synovectomy, major, two or more compartments), says Susan Vogelberger, CPC, business office coordinator for the Orthopedic Surgery Center at Beeghly Medical Park in Ohio.

"The National Correct Coding Initiative bundles 29875 into meniscectomy (29881), but the major synovectomy (29876) is not bundled and can be billed in addition to 29881," Vogelberger says.

Here's how you tell whether the synovectomy is limited or major: If the physician doesn't specifically use the word "compartment" to designate the extent of the procedure, look in your operative report for the phrase "plica resection." This term indicates a limited synovectomy. Some surgeons refer to limited synovectomies as "shelf resections."

The knee consists of three compartments - medial, lateral and patello-femoral - and limited synovectomies include only one area (or compartment) of the knee.

A major synovectomy includes two or more of these areas (or "joint locations"), and is a long and tedious procedure intended to treat extensively diseased internal joint lining as seen in rheumatoid arthritis, pigmented villonodular synovitis or hemophilia.

Therefore, if your surgeon performs a medial meniscectomy and medial and lateral synovectomies, you should report 29881 (Arthroscopy, knee, surgical; with meniscectomy [medial OR lateral, including any meniscal shaving]) and 29876. ACL Repair With Meniscectomy? Break out the Modifiers Question 2: Our surgeon performed an arthroscopic-aided anterior cruciate ligament (ACL) repair, with repair of the medial meniscus and partial lateral meniscectomy. Which codes should we report?

Answer: You should report three codes on three separate lines, as follows: 29888 (Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction) for the ACL repair 29882-51-59 (Arthroscopy, knee, surgical; with meniscus repair [medial OR lateral]; Multiple procedures; Distinct procedural service) for the medial meniscus repair 29881-59 for the partial lateral meniscectomy. The surgeon cannot repair and excise the same meniscus, so because he repaired the medial meniscus and excised the lateral meniscus, you can report both codes.
The operative note should clearly indicate that the surgeon addressed both the lateral and medial menisci to ensure that the payer reimburses both procedures. Tread Carefully With Debridement, Meniscectomy Question 3: [...]


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