# Another Knee Question



## RebeccaWoodward* (Sep 17, 2009)

Please provide your opinion on this op note……

PREOPERATIVE DIAGNOSIS: Right knee pain secondary to medial and lateral meniscal tears.  

POSTOPERATIVE DIAGNOSES: Right knee pain secondary to medial and lateral meniscal tears; chondromalacia involving the medial and lateral femoral condyles and patellofemoral joint; inflamed plica and fat pad.  

PROCEDURES: Arthroscopy of right knee with partial medial and lateral meniscectomies; abrasion chondroplasties medial and lateral femoral condyles; wide debridement of inflamed plica and fat pad.  


Inflow cannula was introduced through a superomedial portal, and the irrigant contained epinephrine per protocol.  The arthroscope was introduced through an anterolateral portal, and the knee was scanned with the following findings:

1.	Suprapatellar pouch normal.  

2.	*Patellofemoral* joint demonstrated grade 2/3 chondromalacia changes on the patellar side and grade 3 changes on the femoral trochlea.  There was an inflamed plica and fat pad, which was impinging into the patellofemoral joint.  

3.	*Medial compartment *showed grade 3 chondromalacia changes on the majority of the medial femoral condyle, with thinning of the medial tibial articular cartilage.  There was a tear of the medial meniscus extending from the junction of the middle and posterior thirds posteriorly.  There was also inflamed synovium and fat pad that was clearly impinging into the medial compartment.  

4.	The intercondylar notch showed an inflamed ligamentum mucosum and fat pad.  The anterior and posterior cruciate ligaments were intact.  There was some osteophytic narrowing of the intracondylar notch.  

5.	*Lateral compartment *showed grade 3 chondromalacia changes on a large part of the lateral femoral condyle.  There was undersurface tearing of the lateral meniscus in the posterior horn, as well as tearing of the anterior horn.  

A probe was introduced through an anteromedial portal, and the extent of the medial and lateral meniscal tears were defined by probing and partial meniscectomies performed back to a stable rim on each side using combination of punch, shaver, and electrocautery.  The undermined articular cartilage on the medial and lateral femoral condyles was then smoothed with abrasion chondroplasty technique.  I then performed a wide debridement of the inflamed plica and fat pads such that at the end of the debridement there was no further ability of any of these tissues to impinge into any of the 3 compartments of the knee.  

Charges were originally entered as 29879 & 29881

Here’s what I think is correct……..29880 (since a medial AND lateral meniscectomy was performed)

29875 since a debridement of the inflamed plica was performed in the Patellofemoral compartment.

NO 29879 since the chondroplasties took place in the same compartments as the meniscectomies.

Since I completley disagree with original coding, I'm double checking.  Now...I could be wrong and overlooking something...that's why I need your opinions...


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## nyyankees (Sep 17, 2009)

yes you would be correct. 29880 for lateral + medial menisectomies + 29875 (synovectomy) for debridement of plica in patellafemoral compartment.

I do not see 29879 (microfracture). Hope this helps.


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## RebeccaWoodward* (Sep 17, 2009)

I does indeed!  Thank you.  Another reason why the person posting the charge(s) must compare the charge slip with the operative note but that's a whole other topic......


Thanks again


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## Bella Cullen (Sep 18, 2009)

yeah I would also agree with 29880 and 29875-59 (since 29875 is a separate procedure code per CPT).


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## RebeccaWoodward* (Sep 18, 2009)

Thanks so much...

I reiterated to the employee responsible for posting these charges that's it's essential that they read the op-note BEFORE posting the charges.  As you can see, reading the op note produced different codes.


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## Bella Cullen (Sep 18, 2009)

rebeccawoodward said:


> Thanks so much...
> 
> I reiterated to the employee responsible for posting these charges that's it's essential that they read the op-note BEFORE posting the charges.  As you can see, reading the op note produced different codes.



Your welcome,
Yeah it *definitely* helps with chosing the correct codes. 
Is that charge poster a coder? Because at my last job the charge posters were not certified coders and they just didn't care. They would say I'm not the coder, that's not my job. Yeah it was frustrating that is why I'm not there anymore. LOL.


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## coderguy1939 (Sep 18, 2009)

You may want to query the doctor and determine if the abrasion chondroplasty he performed in the lateral compartment was down to bleeding bone.  If so, you could, per AAOS GSD guidelines, code 29880 and 29879.


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## Bella Cullen (Sep 18, 2009)

But if there was no microfractures or drilling and just chondroplasties on the same compartments as the meniscal tears I would not code for that separate. 
Just my opinion.


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## coderguy1939 (Sep 18, 2009)

From the lay description of 29879:

The cartilage is smoothed down to the layer of subchondral bone which promotes bleeding and regeneration of cartilage. Any loose bodies are removed. The physician may also drill holes into the subchondral bone or create tiny fractures (microfractures) to further promote cartilage regeneration.

I think the key words here are may also drill holes.

From a 2005 AAOS Bulletin:
According to the AAOS GSD, code 29879 covers: synovial resection for visualization; removal of osteochondral and/or chondral bodies (attached); diagnostic arthroscopy; chondroplasty; lavage and drainage; lysis of adhesions, and manipulation of the knee. It does not include arthroscopic meniscectomy and/or repair or arthroscopic removal of loose bodies or foreign bodies 5 mm or greater and/or through a separate incision.


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## RebeccaWoodward* (Sep 18, 2009)

coderguy1939 said:


> You may want to query the doctor and determine if the abrasion chondroplasty he performed in the lateral compartment was down to bleeding bone.  If so, you could, per AAOS GSD guidelines, code 29880 and 29879.



He didn't...but thanks for the information. 

No...this employee is not a coder. She's a good employee, however, I do feel that the coders (2 of us) should oversee ALL the surgical coding.  However, others do not see "eye to eye" on this.  If she makes a mistake, I don't necessarily fault her...she can only go by what she knows.


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## Bella Cullen (Sep 18, 2009)

rebeccawoodward said:


> He didn't...but thanks for the information.
> 
> No...this employee is not a coder. She's a good employee, however, I do feel that the coders (2 of us) should oversee ALL the surgical coding.  However, others do not see "eye to eye" on this.  If she makes a mistake, I don't necessarily fault her...she can only go by what she knows.



Yeah I agree with you, I think the coders should review all the surgical coding as well, but they should know the concept of it. Everyone makes mistakes sometimes.


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