Orthopedic Coding Alert

Question: Our surgeon performed a meniscectomy (29880) and encountered a hypertrophic impinging deep lateral and medial patella tendon bursa, which made it very difficult to see the areas he was addressing. He excised the bursa medially and laterally. Can I report 27340 even though he excised the bursa arthroscopically?


New York Subscriber
 

Answer: You should not report 27340 (Excision, prepatellar bursa) for the medial and lateral excisions.

First, this code represents an open procedure, and you should not report it for arthroscopic procedures. And more important, you cannot separately report surgical maneuvers that the surgeon performs arthroscopically simply to facilitate visualization of the joint. 

If the patient's anatomy made the procedure unusually complex, you could consider appending modifier 22 (Unusual procedural services) to 29880 (Arthroscopy, knee, surgical; with meniscectomy [medial AND lateral, including any meniscal shaving]).

If the surgeon performed the bursectomy for therapeutic reasons (and not simply to facilitate visualization), the appropriate arthroscopic bursa excision code is 29875 (Arthroscopy, knee, surgical; synovectomy, limited [e.g., plica or shelf resection] [separate procedure]).

However, the National Correct Coding Initiative bundles 29875 into 29880. You can append modifier 59 (Distinct procedural service) to 29875 if the surgeon performed the bursectomy and the meniscectomy in separate compartments (for example, if he treated a lateral bursa and a medial meniscus).