CODING CORNER: Look Closely for Proper Knee Arthroscopy Payment

Understand code intent for improved cash flow
Physicians perform knee arthro- scopies for multiple joint conditions, and knowing both the patient's condition and whether the procedure is diagnostic or surgical will help you unlock the correct code -- and earn appropriate reimbursement for your facility.
Decide the Reason for the Procedure
There are two main arthroscopy types: diagnostic and surgical.
With diagnostic arthroscopies, the doctor may have seen symptoms of the patient's problem, and previous tests -- such as x-rays, MRIs and CT scans -- may have failed to show anything unusual. But the patient still has pain, effusion, or joint instability.
Physicians perform surgical arthroscopies, on the other hand, to treat conditions or abnormalities they already know about. Usually, these problems are abnormalities or injuries in the joint in which there is torn cartilage and arthritis, and she's performing the procedure to repair it.
All surgical arthroscopies include a diagnostic arthroscopy, says Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopaedic Associates in New Brunswick, N.J. But there are certain unique occasions in which you can code both procedures, and that's where intent becomes the pivotal factor.
For example, suppose the physician performs the procedure intending only to determine the nature of the patient's problem, finds a tear or loose piece of debris, and repairs the tear or removes the foreign body. In this case, you can report both a diagnostic and a surgical arthroscopy, says Annette Grady, CPC, CPC-H, senior healthcare consultant at Eide Bailly LLP in Bismarck, N.D.
According to the National Correct Coding Initiative, "When more than one procedure is attempted in direct succession to accomplish the same end, only the successful procedure should be submitted (this generally applies to limited procedures that are unsuccessful, mandating a more comprehensive procedure). Procedures performed at the same session that are diagnostic and establish the decision to perform the more comprehensive service may be separately submitted."
The key: Be sure to add modifier -59 (Distinct procedural service) to the diagnostic code to indicate a separate procedure.
Count Compartments for Synovectomy Codes
You have two choices when reporting knee synovectomies: 29875 (Arthroscopy, knee, surgical; syn-ovectomy, limited) and 29876 (... major, two or more compartments).
Here's how you tell whether the synovectomy is limited or major: If the physician doesn't specifically use the word "compartment" to designate the extent of the procedure, look in your operative report for phrases such as "removed with motorized suction," "cutting resector," and "plica resection," Grady says. These indicate a limited synovectomy, and you'll know to report 29875.
Hint: Limited synovectomies are also [...]

- Published on 2004-07-09