# Can 29895 be billed with 29897 & 29891



## codegirl0422 (Oct 17, 2014)

Hello,

Can 29895 be billed with 29897 & 29891? I got a edit saying 29895 was a component of comprehensive code 29897. But I found this on AANA and I am now questioning myself.

CPT Code: 29897
Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, limited

Intraoperative services included in the global service package:
1. local infiltration of medication(s), anesthetic, or contrast agent before, during, or at the conclusion of the operation
2. suture or staple removal by operating surgeon or designee
3. surgical approach, with necessary identification, isolation, and protection of anatomic structures, including hemostasis and minor skin scar revision
4. obtaining wound specimen(s) for culture
5. wound irrigation
6. intraoperative photo(s) and/or video recording, excluding ionizing radiation
7. intraoperative supervision and positioning of imaging and/or monitoring equipment by operating surgeon or assistant(s)
8. insertion, placement, and removal of surgical drain(s), re-infusion device(s), irrigation tube(s), or catheter(s)
9. closure of wound and repair of tissues divided for initial surgical exposure, partial or complete
10. application of initial dressing, orthosis, continuous passive motion, splint or cast, including traction, except where specifically excluded from global package
11. synovial resection for visualization
12. manipulation under anesthesia (eg, 27860)

Intraoperative services not included in the global service package:
1. supplies and medication (eg, code 99070, HCPCS Level II codes)
2. insertion, removal, or exchange of nonbiodegradable drug delivery implants (eg, 11981?11983)
3. arthroscopic removal of loose or foreign bodies greater than 5 mm or through a separate incision (eg, 29894)
4. arthroscopic synovectomy (eg, 29895)
Medicare global fee period: 90 days

op note: 

POSTOPERATIVE DIAGNOSIS
Ankle hypertrophied synovium and also osteochondral defect of the medial talar dome.
OPERATION
Ankle joint synovectomy with use of ankle arthroscopy and debridement and microfracture of medial
talar dome osteochondral defect

The right foot and ankle was prepped and draped in the usual
aseptic manner and the patient was placed in the GUHL noninvasive ankle distractor system. Right
ankle was exsanguinated utilizing an Esmarch bandage and a thigh tourniquet was raised to 325 mm/Hg
and sustained throughout the procedure as a thigh tourniquet. Attention was then directed to the ankle
where two ports were performed, one medial to the tibialis anterior tendon at the joint line and one
lateral to the peroneus tertius tendon at the ankle joint line. Spinal needles were utilized to identify these
portals. A small stab incision was performed adjacent to each needle and dissection was carried bluntly
down to the level of the joint capsule. At the level of the joint capsule, a sharp obturator was used to
pierce the capsule and then we entered the joint with a blunt obturator. We were able to evaluate initially
with the scope lateral and the shaver medial and switched them halfway through the procedure. We
debrided a large amount of hypertrophied synovium over the ankle joint and easily identified a very
large osteochondral defect of the medial talar dome. We abraded and removed loose cartilaginous tissue
and the surrounding margins of the osteochondral defect. We also used a microfracture pick and
multiple small areas of the subchondral bone are permeated with the pick to bleeding tissue. The anterior
joint capsule was found to be significantly hypertrophied and debridement of this was performed
aggressively. After completed, we had debrided aggressively the osteochondral defect and removed all
hypertrophied synovium over the anterior joint capsule. The patient tolerated the procedure and
anesthesia well. Instrumentation was removed. Then 2 mL of dexamethasone phosphatase
postoperatively along with 20 mL of 0.75 Marcaine plain. Two stitches were applied to close the ports
with 4-0 nylon suture. The wound was then dressed with Betadine soaked gauze, dry sterile
compressive dressing were applied to the foot and ankle. Patient tolerated the procedure and anesthesia
well and left the operating room with vital signs stable and neurovascular status grossly intact.


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## codegirl0422 (Oct 20, 2014)

Any help on this would be greatly appreciated.


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## dclark7 (Oct 20, 2014)

According to the NCCI edits 29895 is a column two code to 29897 but a modifier is allowed.  Just my opinion, but in your op note the synovectomy seems incidental to the other procedures so I would not code it.


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## KMCFADYEN (Oct 21, 2014)

I agree.


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