Orthopedic Coding Alert

Patients who report for knee injuries will often require arthroscopies to figure the scope and severity of the injury. These arthroscopies typically start out as diagnostic procedures — but usually end with a surgical option.

For diagnostic knee arthroscopies that turn surgical, you’ll need to discover several key points of information that will lead you to the correct CPT^® surgical code.

Here’s a rundown of knee arthroscopy coding, along with a coding example.

Look to These Codes for Knee Arthroscopy

When the provider performs a diagnostic knee arthroscopy, the code choice is easy: you’ll report 29870 (Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)) for the service.

“A provider would perform a diagnostic knee scope to better evaluate a problem within the knee. This is usually referred to as a ‘scout’ procedure,” explains Wayne Conway, CPC, CRC, CGSC, COSC, physician coder II at WakeMed Physicians Practice in Raleigh.

“Many times, through test or imaging the physician will have an idea what the problem is; but a diagnostic arthroscopy helps to confirm the exact problem/diagnosis,” explains Conway.

If things turn surgical, however, coding can get complicated fast. Have your encounter notes at the ready when you choose from the surgical knee arthroscopy codes; you’ll need them when sorting through the 15-plus surgery codes you’ll have to choose from.

Some of the more frequently used surgical knee arthroscopy CPT^® codes are:

• 29871 (Arthroscopy, knee, surgical; for infection, lavage and drainage)
• 29873 (…with lateral release)
• 29874 (… for removal of loose body or foreign body (eg, osteochondritis dissecans fragmentation, chondral fragmentation))
• 29880 (… with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/ shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed)
• 29881 (… with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/ shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed)
• 29882 (… with meniscus repair (medial OR lateral))
• 29885 (… drilling for osteochondritis dissecans with bone grafting, with or without internal fixation (including debridement of base of lesion))

Note: As previously mentioned, there are at least 15 surgical codes to choose from. This is not an exhaustive list; always code each encounter to the notes you have to arrive at the proper code choice.

Example: Dx Arthroscopy Turned Surgical

Once a knee arthroscopy makes a surgical turn, you must abandon 29870 and choose a surgical code. Also, you cannot report 29870 and then report a surgical knee arthroscopy for the same injury on the same knee. All the surgical arthroscopy codes include the work involved in performing 29870.

Check out this example from Conway:

A patient is playing soccer and hears a “pop” followed by right knee pain and swelling. The next day the patient has a diagnostic knee arthroscopy. A bucket-handle lateral meniscus tear is confirmed.

Following the diagnostic knee scope, the surgeon performs a repair of the bucket-handle lateral meniscus tear.

On this claim, you’ll report

• 29882 for the meniscus repair.
• Modifier RT (Right side) appended to 29882 to indicate laterality.
• S83.251A (Bucket-handle tear of lateral meniscus, current injury, right knee, initial encounter) appended to 29888 to represent the bucket-handle tear.