ASC Focus: Master Terminology to Nail Knee Arthroscopy Coding

Check CCI for bundles before reporting multiple codes

When reporting knee arthroscopy (29870-29889), you should know which knee “compartment(s)” the surgeon addressed. The compartments are important for coding because the national Correct Coding Initiative (CCI) bundles procedures performed in the same compartment.
For example, if the physician performs a medial meniscectomy and a concurrent synovectomy on the knee’s medial side, you may charge only one code because both structures are in the same compartment.


Look for These Key Terms

If you see any of the following terms in the op note, the procedure occurred in the medial compartment:


medial meniscus��'-- anterior and posterior horns

medial femoral condyle

medial tibial plateau

medial ligamentous structures��'-- medial collateral ligament (internally).


Look for the following terms to indicate that the surgeon addressed the lateral compartment:


lateral meniscus��'-- anterior and posterior horns

lateral femoral condyle

lateral tibial plateau

lateral ligamentous structures��'-- lateral collateral ligament (internally) and the popliteus tendon.
You can rest assured that the surgeon addressed the patello-femoral compartment if he documents something like this: Surgery in the deep surface of the patella or the superficial surface of the anterior femur, usually termed the “trochlear groove.”
Be on the lookout: A fibrous structure, termed a “plica,” is most often located in the patello-femoral compartment of the knee but can be in any compartment.
If you’re unsure of the plica’s location that your surgeon documents, ask the physician specifically which compartment he addressed.


1 Compartment = 1 Code

Payers usually interpret CCI edits to mean that you may report only one code for each compartment the surgeon addresses. For example, this problem often occurs when a patient has a meniscal tear and a concomitant osteochondral defect in the same compartment, usually a defect on the medial femoral condyle.
During arthroscopy, most surgeons will address both problems, says Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network LLC. For example, they’ll perform a medial meniscectomy (or repair) and shave the osteochondral defect, termed a “chondroplasty” for coding purposes, during the same operative session. The codes for these are 29881 (Arthroscopy, knee, surgical; with meniscectomy [medial OR lateral, including any meniscal shaving]) or 29882 (... with meniscus repair [medial OR lateral]), and 29877 (... debridement/shaving of articular cartilage [chondroplasty]).
But CCI bundles 29877 into both 29881 and 29882, and you cannot report them together [...]

- Published on 2007-08-24