Question: An orthopedic surgeon performed knee arthroscopy with lateral release and vastus medialis oblique (VMO) plication. Would adding modifier 22 to 29873 be sufficient to cover the VMO portion of the surgery?
Pennsylvania Subscriber
Answer: Yes, that should be enough to report the arthroscopic knee surgery and the muscle plication.
CPT® code 29873 (Arthroscopy, knee, surgical; with lateral release) accurately describes the arthroscopic knee surgery with a lateral release. Appending modifier 22 (Increased procedural services) to the procedure code along with the operative note indicating the surgeon attached the VMO muscle to the patella (kneecap).
Some coders may be tempted to assign 27422 (Reconstruction of dislocating patella; with extensor realignment and/or muscle advancement or release (eg, Campbell, Goldwaite type procedure)) to report the VMO plication portion of the procedure, but there is an issue with this plan. Code 27422 is an open procedure, and you indicated the orthopedic surgeon performed knee arthroscopy, which is not an open procedure.
Modifier 22 is used when the physician needs to perform more than what is usually needed during the procedure. In this case, the VMO plication isn’t listed as part of 29873’s descriptor, so appending modifier 22 and drawing attention to the documentation is a good plan.
Of course, you can contact the payer about this unique situation and see how they prefer you to report the procedure.
Mike Shaughnessy, BA, CPC, Development Editor, AAPC
