Orthopedic Coding Alert

Compartment, incision, size of foreign body are your guides.

Coding chondroplasties with primary procedures can be a real challenge, especially if you're reporting arthroscopic chondroplasties with removal of foreign or loose bodies in the knee. Understanding when and how to report these procedures together will enhance your claims success.

Don't Lean On Modifier 59

You will turn to CPT® code 29877 (Arthroscopy, knee, surgical; debridement/shaving of articular cartilage [chondroplasty]) to report an arthroscopic chondroplasty which your surgeon does in the medial, lateral, and/or patellofemoral compartment(s). You, however, need to exercise caution that you report code 29877 only once per session of surgery and only when your surgeon does the chondroplasty in a compartment different from that of the primary surgical procedure.

Caveat: You no longer append modifier 59 (Distinct procedural service) to indicate that your surgeon did the chondroplasty in a compartment different from that of the primary surgical procedure. The modifier 59 no longer applies when chondroplasty is performed with meniscectomy.

Rationale: CPT® 2012 features amended procedure descriptions for codes 29880 (Arthroscopy, knee, surgical; with meniscectomy [medial AND lateral, including any meniscal shaving] including debridement/shaving of articular cartilage [chondroplasty], same or separate compartment[s]), when performed) and 29881 (Arthroscopy, knee, surgical; with meniscectomy [medial OR lateral, including any meniscal shaving] including debridement/shaving of articular cartilage [chondroplasty], same or separate compartment[s], when performed), and chondroplasty is now included, regardless of the compartment in which it is performed," says Heidi Stout, BA, CPC, COSC, PCS, CCS-P, Coder on Call, Inc., Milltown, New Jersey and orthopedic coding division director, The Coding Network, LLC, Beverly Hills, CA. "CPT® has made it clear that there are no circumstances under which it would be appropriate to report code 29877 in addition to either 29880 or 29881," she adds.

These Factors Determine Your 29874 Use

Another code that may pose a challenge for you in reporting the arthroscopic knee procedures is the CPT® code 29874 (Arthroscopy, knee, surgical; for removal of loose body or foreign body [eg, osteochondritis dissecans fragmentation, chondral fragmentation]). Note that you may report code 29874 in addition to codes like 29881 or 29880 for other arthroscopic knee procedures.

Caution: But you may do so only if the arthroscopic foreign body was greater than 5 mm, the foreign body was removed through a separate incision or portal (and not through the inflow or outflow portal), or if performed in a separate knee compartment. "The AAOS still advocates reporting code 29874 in addition to 29881 or 29880 when the loose body is over 5 mm in size, is removed via separate incision, or if performed in a separate knee compartment," says Stout. "These codes do not apply to Medicare reporting as CCI deems loose body removal inclusive."

"Separate reporting for loose body removal when in a separate compartment or separate incision is supported by the AMA, CCI and AAOS. Only AAOS supports by size," says Ruby O'Brochta-Woodward, BSN, CPC, CCS-P, COSC, ACS-OR, compliance and research specialist, Twin Cities Orthopedics, P.A. 

The CCI edits do not allow the reporting of 29874 and 29881 or 29880. "CCI edits now list this combination as 'never allowed, under any circumstances'," says Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner, Precision Auditing and Coding, senior orthopedic coder & auditor, The Coding Network, Washington

Example: If you read that your surgeon uses an arthroscopic approach to remove a loose body measuring 8 mm in the medial compartment and also does a meniscectomy with chondroplasty in the medial and lateral compartments, you report codes 29874 along with 29880 for the two procedures. You can report the two together as the foreign body is exceeding the 5 mm size that is described by AAOS. Do not append modifier 59. Note that 29880 is inclusive for chondroplasty and you do not report any other code for this.