Anotomy of knee:
Knee arthroscopic procedures
Anotomy of knee:
The medical compartment includes:
- Medial Femoral condyle
- Medial tibial plateau
- Medial meniscus
The lateral compartment includes
- Lateral Femoral condyle
- Lateral tibial plateau
- Lateral meniscus.
The patellofemoral compartment includes
- Patella
- Patellofemoral joint
- Intercondylar notch of the femur
- Suprapatellar pouch
- Trochlea
Bones
- Femur
- Tibia
Arthroscopy
Knee arthroscopy allows the physician to visualize the joint space of the knee using a fiberoptic endoscope. (An endoscope is basically a long tube with a lens at each end. Endoscopes used to visualize joint spaces are called arthroscopes.
Arthroscopic knee surgery usually involved at least two incisions. The first incision is made on the lateral side of the patellar incision—this is where the arthroscope is inserted. Additional incisions are made, one on the medial side of the patellar tendon and others as needed, for the insertion of surgical instruments.
When reporting services, the first determinations need to be what type of procedure was performed:
- Repair
- Reconstruction
- Debridement
- An excision
- And what technique was used: open or arthroscopic
An arthroscopically aided ACL repair/reconstruction includes the following:
- Insertion of synthetic bone substitute bone matrix/methylmethacrylate
- Internal fixation of graft
- Notchplasty
- Insertion or placement of surgical drain
- Closure of the wound and repair of tissues for initial surgical exposure. Only complicated wound closures and those requiring flaps or grafts may be separately billed
- Harvesting of the graft (fascia, tendon, or bone), even if performed through a separate incision.
29876 Arthroscopy, knee, surgical; synovectomy, major, 2 or more compartments (e.g., medial or lateral)
29881—Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving), including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed
29883- Arthroscopy, knee, surgical; with meniscus repair (medial AND lateral)
If a knee arthroscopy for removal of loose or foreign bodies (29874) is performed in the same knee compartment as procedures described by codes 29875-29881, then code 29874 should not be reported separately, as this is considered to be an inclusive component of codes 29875-29881.
However, if a knee arthroscopy for removal of loose or foreign bodies (29874) is performed in a different knee compartment as the knee arthroscopy procedure codes 29875-29881, then code 29874 may be reported separately with modifier -59, Distinct Procedural Service, appended.
For example, when smoothing down the cartilage and/or drilling holes to create microfractures is also performed in addition to removal of foreign bodies or loose bodies of the bone or cartilage within the knee joint, code 29879 may be reported in addition to code 29874 only if performed in a separate knee compartment. Modifier -59 should be appended to indicate that a separate compartment was involved.
If debridement or shaving of articular cartilage and meniscectomy are performed in the same compartment of the knee, then only code 29881, Arthroscopy, knee, surgical; with meniscectomy (medial or lateral, including any meniscal shaving), should be reported.
However, if debridement or shaving of articular cartilage is performed in one compartment of the knee and a meniscectomy is performed in a different compartment of the knee, then codes 29877, Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty), and 29881 should be reported
An important HCPCS code is G0289, Arthroscopy, knee, surgical, for removal of loose body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee. This code is used for Medicare patients to report the procedure in that description when performed in a separate compartment of the knee during the same operative session. It is not appropriate to use code 29877 even with a modifier
HCPCS code G0289 may be reported in addition to CPT® code 29880, Arthroscopy, knee, surgical; with meniscectomy (media AND lateral, including any meniscal shaving) or CPT® code 29881, Arthroscopy, knee, surgical; with meniscectomy (medial or lateral, including any meniscal shaving) if performed in a separate compartment
Example
An arthroscopy with a medial meniscectomy and shaving of the articular cartilage in the lateral compartment is performed on the left knee, commercial carrier.
• 29881-LT – identifies the excision of the meniscus
• 29877-LT-59 – identifies debridement/shaving of the cartilage
An arthroscopy with a medial meniscectomy and shaving of the articular cartilage in the lateral compartment is performed on the left knee of the Medicare patient.
• 29881-LT – identifies the excision of the meniscus
• G0289-LT—identifies debridement/shaving of the cartilage
An arthroscopy for medial meniscal repair with a patellofemoral chondroplasty
• 29882 – Arthroscopic meniscal repair
• 29887-59 – arthroscopic Patellofemoral chondroplasty
If an arthroscopic procedure is performed at one site and an open procedure is performed at a different site, a modifier should be used to indicate this (-59, RT, LT, etc.).
A patient had a medial compartment meniscectomy (29881) and a lateral compartment synovectomy (29875), and both procedures were performed in different compartments of the knee. Would it be appropriate to separately report these procedures?
Answer: No. Code 29875, which describes limited synovectomy, is for a separate procedure.
This means that the work associated with this procedure is inclusive of more extensive procedures performed in the same anatomic site (the knee) and is not separately reportable if another arthroscopic knee procedure is performed on the same knee in the same session.
This code should only be reported if it is the only procedure performed; separate compartment rules do not apply. Code 29875 is a separate procedure and is not reported with code 29881 when performed.
