# Help with knee arthroscopy



## smcbroom (Sep 3, 2008)

I wanted to get your opinion on this case.  Should it be only 29880 or should a 29877 be coded also due to chondroplasty of patella?  There has been some debate in our office as to correct coding.  It is a commercial payer and I work at an ASC.  Any suggestions would be appreciated!!

PREOPERATIVE DIAGNOSIS:
Left knee medial meniscal tear.

POSTOPERATIVE DIAGNOSES:
1.  Left knee medial meniscal tear.
2.  Lateral meniscal tear.
3.  Grade II chondrosis of patella, medial femoral condyle, and lateral tibial plateau.

PROCEDURES PERFORMED:
1.  Left knee arthroscopy with partial medial and lateral meniscectomies.
2.  Chondroplasty of the patella, medial femoral condyle, and lateral tibial plateau.

ANESTHESIA:
General.

COMPLICATIONS:
None.

BLOOD LOSS:
Minimal.

TOURNIQUET:
None.

INDICATIONS:  
Sandie is a 60-year-old woman with a history of medial knee pain and mechanical symptoms and an MRI showing a medial meniscal tear.  She has failed conservative treatment and was indicated for arthroscopic management.

FINDINGS:
Exam under anesthesia revealed a moderate effusion and full range of motion 2 quadrants of medial and lateral patellar glide, neural passive patellar tilt.  Ligamentous exam was stable.

Arthroscopic examination of the suprapatellar pouch and medial and lateral gutters was unremarkable.  Examination of the patella revealed some loose chondral flaps at the superior pole and the inferolateral pole, otherwise the articular surface was intact.  Examination of the trochlea revealed no significant chondral lesion.  Examination of the notch revealed the cruciate ligaments to be intact.  Examination of the lateral compartment revealed a flap tear off the posterior horn of the lateral meniscus.  There was some grade II fibrillation of the lateral tibial plateau.  Examination of the medial compartment revealed a sudden increase in opening with resulting from a grade II MCL injury with just moderate valgus stress on the compartment.  Following this, she had grade II valgus laxity with a good endpoint on valgus stress.  Again, this occurred with only moderate valgus stress and it was felt to likely represent a reinjury to the MCL.  There was just a partial tear and it was felt that it would probably heal up nicely with conservative treatment postoperatively.  There was a complex degenerative tear of the posterior horn of the medial meniscus with several loose underside flaps of the meniscus.  There was a small grade II-III chondral lesion of the medial femoral condyle just adjacent to the notch with some loose chondral flaps.

PROCEDURE IN DETAIL:
Following induction of general anesthesia, the left thigh tourniquet and thigh holder were applied.  The right leg was placed in a well?leg holder.  Under sterile conditions, the left knee was injected with 30 cc of 0.25% Marcaine with epinephrine in a standard fashion.  The left lower extremity was then prepped and draped in the usual fashion.

Standard anterolateral and anteromedial portals with superolateral outflow were established and diagnostic arthroscopy was performed with the findings as above.  The shaver was used to debride the posterior horn of the lateral meniscus as well as the fibrillated articular cartilage on lateral tibial plateau.  Next, the basket and shaver were used to resect the unstable meniscal flaps from the posterior horn of the medial meniscus and the remaining meniscus was smooth with the shaver and then stable to probing.  The shaver was also used to debride the chondral flap from the medial femoral condyle.  Next, the shaver was used to debride the chondral flap from the patella.

The arthroscope was withdrawn.  The portals were closed with nylon sutures and 30 cc of 0.25% Marcaine with epinephrine was instilled into the joint.  A sterile dressing was applied followed by a TED hose and a knee immobilizer.  The patient was awakened and extubated in the operating room and transferred to the recovery room in stable condition.


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## trose45116 (Sep 3, 2008)

what payer are you billing for this?


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## mmendoza (Sep 3, 2008)

*Cci*

The National Correct coding guidelines state NEVER to bill these codes when performed in same session. I work for an ASC spec in Ortho and I never bill unless the 29880 Rt and 29877 Lt that would be the only time to bill both. I do understand you are billing for a private Ins but the guidelines still apply, in the case that this Ins you are billing does not take in consideration the codes and pays off of the amount billed than I would consider it fraudulent to bill both since 29877 is bundled into 29880.

Hope my opinion helps.


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## mbort (Sep 4, 2008)

I disagree with mmendoza, the AMA (owner of CPT) states it is okay to code out both for private carriers.  The guidelines for the 29877/G0289 apply to Medicare.  I would code the 29880 with the 29877 if the documentation supports a seperate compartment.  Please see below from CPT assistant:

Musculoskeletal System/Surgery

Question: If debridement or shaving of articular cartilage and meniscectomy are performed in the same compartment of the knee, can codes 29881 and 29877 be reported together?

AMA Comment:From a CPT coding perspective, 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. Modifier 59, Distinct procedural service, should be appended to the secondary procedure to indicate that the procedure was performed in a different site (ie, different compartment of the knee) than the first procedure.

*and*

Year: 1999 

Issue: June 

Pages: 11 

Title: Surgery Musculoskeletal System, 29877 (Q&A) 

Body: Coding Consultation

Question

The February 1996 issue of the CPT Assistant featured a question in the coding consultation section regarding coding for an arthroscopy of the knee with a lateral meniscectomy and shaving the articular cartilage. Please clarify whether these procedures must be performed in separate compartments of the knee in order to separately report these procedures.

AMA Comment

Yes. In order to separately report arthroscopic debridement/shaving of articular cartilage (29877) and arthroscopic meniscectomy (29880, 29881) performed at the same session, the procedures must be performed in separate compartments of the knee.

To further clarify, there are three compartments of the knee commonly visualized during arthroscopic surgery: medial, lateral, and patellofemoral. When reporting meniscectomy and shaving of articular cartilage performed in separate compartments of the knee at the same session, appending the -59 modifier to the second procedure will communicate that the procedures were performed in separate compartments of the knee.


© 2005 American Medical Association


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## smcbroom (Sep 4, 2008)

thank you for your opinions, I am going with MBort's answer  since there are different compartments stated, it's just always a confusing subject for most of us when coding knee and shoulder procedures and I wanted to see what others thought.  I guess if my instinct tells me it's right then I should go with it.


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## boyett (Jul 15, 2014)

*Florthocoder*

i am also wondering can you bill 29877,29877-59 if the dr does superior compartment shaving as well as medial compartment shaving without doing the menisectomy.


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