What Makes Synovectomy Separate? Our Experts Respond

Rely on modifier 59 to indicate separate compartment
When reporting same-day meniscectomy and synovectomy claims, you should look to the surgeon’s documentation for evidence that the procedures occurred in a different knee compartment. If so, you may be able to enhance reimbursement -- depending on the surgeon’s reason for clearing the synovium.

Bundle Same-Compartment Procedures

If the surgeon performs synovectomy (29875, Arthroscopy, knee, surgical; synovectomy, limited [e.g., plica or shelf resection]: APC 0041) in the same knee compartment in which she also performs single-compartment meniscectomy (29881, … with meniscectomy [medial OR lateral, including any meniscal shaving: APC 0041), you will report only the more-extensive meniscectomy procedure.
CPT designates limited synovectomy code 29875 as a "separate procedure." "Codes with the ‘separate procedure’ designation normally would not be additionally reported when the procedure or service is performed as an integral component of another procedure or service," explains the August 2001 CPT Assistant.
In addition, the national Correct Coding Initiative (CCI) bundles 29875 to 29881, reinforcing that you would not normally bill these codes together.
Example: As part of left lateral meniscectomy, the orthopedic surgeon performs arthroscopic synovectomy in the lateral compartment of the left knee. In this case, you would report only 29881 because the meniscectomy includes synovectomy in the same knee compartment.

Report Separate Compartments Separately

If the surgeon performs synovectomy independently of meniscectomy, you may claim the synovectomy. For example, if the surgeon performs a medial synovectomy and lateral meniscectomy, you should report 29875 separately, in addition to 29881 for the meniscectomy, because the synovectomy occurred in a different compartment.
When reporting 29875 separately, be sure to append modifier 59 (Distinct procedural service) to indicate to the payer that the synovectomy occurred at a separate location. AMA guidel ines support this coding. CPT Assistant, August 2001, specifically states, "If the knee arthroscopy with limited synovectomy were performed in a different knee compartment than another knee procedure, modifier 59 would be appended to code 29875 to indicate that a different compartment was involved."
CCI also allows you to append modifier 59 to unbundle 29875 from 29881 for procedures in different areas.
"You should add modifier 59 only if the physician performs synovectomy in a different compartment from the major procedure," advises Carol A. Emmons, CPC, senior coding and reimbursement specialist for a major New Jersey workers’ compensation carrier. "We find providers incorrectly appending the modifier and expecting to be paid even though the synovectomy takes place in the same compartment as the major procedure."

Be Consistent When Compartment Count Rises

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- Published on 2008-07-08