Orthopedic Coding Alert

Question: Our orthopedist did a right knee arthroscopy with extensive tricompartmental synovectomy, partial medial menisectomy, and chondroplasty of patella and femoral trochlea. I'm using 29876, 29881, and G0289 -- but I'm not sure if G0289 is right. Also, when the doctor states "extensive," should I use modifier 22 on 29876?

New York Subscriber

Answer: You should report only 29876 (Arthroscopy, knee, surgical; synovectomy, major, two or more compartments [e.g., medial or lateral]) and 29881 (... with meniscectomy [medial OR lateral, including any  meniscal shaving]).

Warning: You should not 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), because the orthopedist performed the chondroplasty in the same knee compartment as synovectomy.

As for modifier 22 (Increased procedural services), you should be wary when your physician dictates "extensive." His documentation would need to specify a lot of extra time involved, because no other route could justify a modifier 22 on the arthroscopy.