Orthopedic Coding Alert

Question: Below is the operative note that describes the procedures our surgeon did on the patient’s knee.

"The patient’s right knee was prepped and draped in the usual sterile fashion under endotracheal anesthesia. She was given prophylactic antibiotics. Examination showed 2+ effusion and exam showed patellofemoral tracking to be good, but with some crepitus with negative Lachman, anterior drawer, and pivot shift. Examination with the scope showed the effusion to be serous and this was washed free. Patellofemoral tracking was good with chondromalacia, grade III and IV on the patellar side. Debridement was done for the chondrocalcinosis deposits in the medial compartment. The degenerative segments, basically grade V over a fairly large area in the medial femoral condyle, were debrided down with a chondrotome shaver. The medial meniscus showed tears in the anterior two-thirds, this was debrided with biters and shavers. In the notch, the ACL was found to be intact, although there were some chondrocalcinosis deposits noted within the fibers, which also showed degenerative changes. The notch also was fairly stenotic. In the lateral compartment, chondrocalcinosis deposits were found. There was a tear of the anterior two-thirds of the lateral meniscus, again with deposits. In the posterior horn, there was a flap tear with heavy deposits. The deposits were removed with biters and shavers until a stable base from anterior to posterior was achieved. The articular cartilages in the lateral compartments were in relatively better condition. All there compartments were checked again. Suction shaver was used to remove debris and resection was felt to be optimal. The instruments were removed."

Please help us to report these procedures.

New Jersey Subscriber

Answer: The operative note describes debridement and shaving to remove the chondrocalcinosis deposits in the menisci and the articular cartilages of the right knee. You report 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)-RT for the meniscal debridement. The description does give an impression of lateral meniscus repair with debridement for which you report code 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). For chondrocalcinosis, you report code 712.36 (Chondrocalcinosis cause unspecified involving lower leg) and 275.40 (Unspecified disorder of calcium metabolism).