Orthopedic Coding Alert

Question: I-ve been hearing conflicting advice regarding whether I may report 29876 with 29881 when the surgeon performs a medial and lateral synovectomy with a medial meniscectomy. Is there any authoritative guidance on the topic?

Michigan Subscriber

Answer: As so often is the case, getting your payer's preference in writing is the safest bet.

One expert shares that, in response to a CPT Information Service query, the AMA stated that you may report the following codes together:

- 29876 (Arthroscopy, knee, surgical; synovectomy, major, two or more compartments [e.g., medial or lateral]) for lateral and medial arthroscopic synovectomy

- 29880 (- with meniscectomy [medial AND lateral, including any meniscal shaving]) for lateral and medial meniscectomy performed at the same session as the 29876 service.

This answer suggests that the AMA supports reporting both synovectomy and meniscectomy when performed in the same compartment at the same session. By that logic, the AMA should support reporting 29876 with 29881 (- with meniscectomy [medial OR lateral, including any meniscal shaving]) when the surgeon performs them at the same session.

Tip: You should append modifier 51 (Multiple procedures) to the meniscectomy code, according to the AMA response. But remember that many payers -- including most Medicare carriers -- don't want you to append modifier 51. The payer will automatically sort the procedures on your claim.

Watch out: Although the AMA is an authoritative source for CPT guidelines, your payer may have its own interpretation of reporting this case properly, particularly if it follows American Academy of Orthopaedic Surgeons (AAOS) advice.

An article in the April 2005 AAOS online bulletin states, "CPT has two codes for synovectomy: 29875 for one compartment and 29876 for two or more compartments. However, this can be misleading. Consider this example: A patient has a medial meniscectomy (29881) along with both medial and lateral synovectomies. Although this is technically a two-compartment synovectomy, the medial synovectomy is included in the code for the medial meniscectomy. Therefore, only a single compartment synovectomy (29875) can be reported."

Translation: The article advises including synovectomy in meniscectomy unless the surgeon performs them in separate compartments.

Experts warn: If the surgeon clears synovium to complete the joint diagnostic exam rather than as a therapeutic procedure, the safest approach is to consider the synovectomy part of the surgical approach rather than coding it separately.