Orthopedic Coding Alert

"

Not every plica excision and bursectomy will warrant separate codes

If you question yourself every time you code a knee surgery report, take a few minutes to brush up on your knee arthroscopy coding basics and you'll be on your way to cleaner claims.

Take a look at the following arthroscopic meniscectomy operative note, submitted by Linda Graham, coder at Nebel Orthopedic Center in Port Huron, Mich., and review our expert's coding recommendations.
 
Procedure Overview: Examine What the Surgeon Performed

Here's a quick synopsis: Diagnostic arthroscopy revealed an anterior horn medial meniscus tear, hypertrophy of the medial and lateral patellar tendon bursae, symptomatic synovial plicae, chondromalacia patellar and chronic anterior cruciate ligament insufficiency.
 
The surgeon performed arthroscopic resection of the disrupted anterior horn of the medial meniscus, excision of the deep medial and deep lateral patellar tendon bursae, excision of the anterior lateral plica and the superior parapatellar plica strands, and a patellar chondrectomy.

Operative Note: Trace the Surgeon's Work

The pertinent details from the operative report follow: After diagnostic arthroscopy was completed, a 4/0 meniscal resector was introduced, and the anterior horn of the medial meniscus was excised. Next, on oscillate the deep lateral and medial patellar tendon bursae were excised.

The anterior lateral plica was excised, and this was a limited synovectomy and went up along the lateral aspect of the femoral condyle. Next, the instruments were passed into the patellofemoral joint region, and strands of parapatellar plica were excised, and a limited patellar chondrectomy of the medial patellar facet had moderate chondromalacia, grade 2.

Know Your Postoperative Diagnoses

Anterior horn medial meniscus tear, right knee (836.0 or 717.1)
 

Deep medial and lateral patellar tendon bursa hypertrophy and impingement, right knee (726.60) 
 

Anterior lateral plica with impingement, right knee (727.83)
 

Parapatellar plica with impingement, right knee (although this condition shares the same diagnosis code as the anterior lateral plica with impingement, you should report 727.83 only once on your claim)
 

Chondromalacia of patella, right (717.7)
 

Chronic anterior cruciate ligament tear, stable, right knee (717.83).

Coding Advice: Follow These 3 Steps

Step 1: Code the arthroscopic meniscectomy. First, report 29881-RT (Arthroscopy, knee, surgical; with meniscectomy [medial OR lateral, including any meniscal shaving]; Right side).

Watch out: Although the patient also had lateral tendon bursa hypertrophy and lateral plica with impingement, you cannot code a medial AND lateral meniscectomy"" (29880) because the surgeon only resected a medial meniscal tear - the patient did not have a lateral meniscus tear.

"

Step 2: Code the chondroplasty. The surgeon documented an arthroscopic patellar chondroplasty. Because he performed the chondroplasty in the patellar compartment and the meniscectomy in the medial compartment you can separately report the chondroplasty.
 
If however he had performed both procedures in the same compartment the insurer would have bundled the chondroplasty into the meniscectomy.

If the surgeon performed the knee surgery on a non-Medicare patient you should report 29877-59 (Arthroscopy knee surgical; debridement/shaving of articular cartilage [chondroplasty]; Distinct procedural service) for the separate-compartment chondroplasty says Heidi Stout CPC CCS-P coding and reimbursement manager at UMDNJ-RWJ University Orthopaedic Group in New Brunswick N.J.

If the surgeon performed the arthroscopic knee surgery on a Medicare patient you should instead report G0289 (Arthroscopy knee surgical for removal of loose body foreign body debridement/shaving of articular cartilage [chondroplasty] at the time of other surgical knee arthroscopy in a different compartment of the same knee) to represent the patellar chondroplasty.

The National Correct Coding Initiative (NCCI) edits restrict you from reporting 29877 with a meniscectomy code even if you perform the two procedures in separate compartments.  

Step 3: Determine whether you can report additional codes. The orthopedist also documented an arthroscopic plica excision but you cannot separately report the service because the surgeon performed the synovectomy in the same compartment as he performed the chondroplasty.

The NCCI bundles 29875 (Arthroscopy knee surgical; synovectomy limited [e.g. plica or shelf resection] [separate procedure]) into 29877 and most insurers follow this guideline and include synovectomy payment in the chondroplasty reimbursement.
 
"The surgeon also performed a bursectomy which I would consider incidental to the physician's other services " Stout says.

Bottom line: You should report 29881 linked to 836.0 (Tear of medial cartilage or meniscus of knee current) for the meniscectomy and either 29877-59 or G0289 (depending on the payer) for the chondroplasty. Link the chondroplasty code to the diagnosis 717.7 (Chondromalacia of patella).

"