# Chondroplasty  and synovectomy of knee



## vinod (Dec 15, 2008)

Chondroplasty of knee - 29877, Partial synovectomy - 29875 

Chondroplasty of knee is the higher value procedure than partial synovectomy. But in the CCI edits,while seeing 29877 it shows 29875 (not allowed) in the CCI Greater px which is a lower dollar value. Usually higher dollar value procedures are shown in the CCI Greater px. 29875 CCI edits shows 29877 is not allowed. Can i code 29877 on the basis of higher dollar value or 29875 as per CCI edit. I have enclosed the report. I Kindly request to clarify this report.

PROCEDURE: The patient was given a general anesthetic. The left knee had a lack of 2U degrees of full extension, crepitation in the anterior aspect of the knee, stable anterior and posterior drawer, Lachman and pivot. The patient had stable collateral ligament. The patient had a tourniquet placed around the proximal left thigh, not inflated at any time. Portals were all injected with lidocaine and epinephrine. Inflow initially was superior medial, switched then through the scope anterior lateral, outflow then superior medial, instrumentation anterior medial, and scope in the anterior lateral portal. Accessory portal was mid lateral patella. The patient then had the scope introduced through the anterior lateral portal, and the suprapatellar pouch was normal with some slight synovitis. There was grade 4 throughout the entire patellofemoral joint with only minimal articular cartilage remnant over the superior medial femoral condyle. The rest was exposed bone. The lateral sulcus had a large free floating loose body. The periphery of the lateral meniscus was intact. The lateral meniscus was intact. The AOL was intact. There was a large free floating loose body just anterior to the AOL. The notch was extremely narrowed and hypertrophic bone preventing full extension. The medial compartment had grade 2 articular changes and intact medial meniscus. Using large grabber the loose body in the anterior aspect of the knee joint just anterior to the AOL was removed without difficulty. The loose body, which was actually larger that was in the lateral sulcus was then removed through the accessory mid lateral patellar incision. Following this inspection for any other loose bodies failed to reveal any. A notchplasty was then performed so that full extension could be performed to the knee joint with slight manipulation. Then following completion of the notchplasty the knee was extended in full extension, and there was no impingement of the anterior compartment or the AOL. The patient then had thorough irrigation performed. Partial synovectomy was done also anteriorly for better visualization. After the irrigation the instrumentation was removed. All the portals were closed with interrupted 4-0 Prolene. Thirty cc of 0.5% Marcaine was instilled in the knee joint. Sterile dressing was applied, and the patient returned to recovery in satisfactory condition.


----------



## mbort (Dec 15, 2008)

vinod said:


> Chondroplasty of knee - 29877, Partial synovectomy - 29875
> 
> Chondroplasty of knee is the higher value procedure than partial synovectomy. But in the CCI edits,while seeing 29877 it shows 29875 (not allowed) in the CCI Greater px which is a lower dollar value. Usually higher dollar value procedures are shown in the CCI Greater px. 29875 CCI edits shows 29877 is not allowed. Can i code 29877 on the basis of higher dollar value or 29875 as per CCI edit. I have enclosed the report. I Kindly request to clarify this report.
> 
> PROCEDURE: The patient was given a general anesthetic. The left knee had a lack of 2U degrees of full extension, crepitation in the anterior aspect of the knee, stable anterior and posterior drawer, Lachman and pivot. The patient had stable collateral ligament. The patient had a tourniquet placed around the proximal left thigh, not inflated at any time. Portals were all injected with lidocaine and epinephrine. Inflow initially was superior medial, switched then through the scope anterior lateral, outflow then superior medial, instrumentation anterior medial, and scope in the anterior lateral portal. Accessory portal was mid lateral patella. The patient then had the scope introduced through the anterior lateral portal, and the suprapatellar pouch was normal with some slight synovitis. There was grade 4 throughout the entire patellofemoral joint with only minimal articular cartilage remnant over the superior medial femoral condyle. The rest was exposed bone. The lateral sulcus had a large free floating loose body. The periphery of the lateral meniscus was intact. The lateral meniscus was intact. The AOL was intact. There was a large free floating loose body just anterior to the AOL. The notch was extremely narrowed and hypertrophic bone preventing full extension. The medial compartment had grade 2 articular changes and intact medial meniscus. Using large grabber the loose body in the anterior aspect of the knee joint just anterior to the AOL was removed without difficulty. The loose body, which was actually larger that was in the lateral sulcus was then removed through the accessory mid lateral patellar incision. Following this inspection for any other loose bodies failed to reveal any. A notchplasty was then performed so that full extension could be performed to the knee joint with slight manipulation. Then following completion of the notchplasty the knee was extended in full extension, and there was no impingement of the anterior compartment or the AOL. The patient then had thorough irrigation performed. Partial synovectomy was done also anteriorly for better visualization. After the irrigation the instrumentation was removed. All the portals were closed with interrupted 4-0 Prolene. Thirty cc of 0.5% Marcaine was instilled in the knee joint. Sterile dressing was applied, and the patient returned to recovery in satisfactory condition.



I do not see a 29877 in this note (notchplasty is not a full chondroplasty).  The synovectomy (29875) was done for visualization so there is no credit for that either.

The only thing I see here is a 29874.  You might also ask your surgeon to start documenting the size of loose bodies too as this can alter coding when other procedures are performed allowing for the -59 modifier.


Hope this helps
Mary, CPC, CPC-ORTHO


----------



## CrysLednum (Dec 17, 2008)

I agree with Mary.  The only thing here is the 29874.  This brings me to a discussion I am in them middle of.

I have a surgery where the doc performed Medial & Lateral menisectomies      (29881), PF chondroplasty (29877) and 29874 (lateral) .  However the only documention is separate incision once the menisectomy was done.  There is no mention of size.

Do you feel the 29874 can be coded even though it was done in same compartment by sep. incision?


----------



## mbort (Dec 18, 2008)

only if you can get him to do an addendum and add the size.  It needs to be mmmmm more than 5mm or 8mm I dont remember and dont have the info with me on the specific size.


----------



## DCoburn (Dec 19, 2008)

Why is'nt the medial and lateral menisectomies coded to 29880.  Also, I would ask the doc for an addendum to state why code 29874 had to be performed through a separate incision.  Which according to AMA's Editorial Panel; you can bill for an procedure performed through an separate incision with the 59 modifier.  "I do understand about performing procedure in the same compartment".


----------

