Orthopedic Coding Alert

Coding shifts when diagnostic becomes surgical.

A common diagnostic tool in an orthopedic office is the knee arthroscopy. Using this technique, the provider can examine if the patient has any underlying injury or issue that might be causing the patient pain — and that might require surgical intervention.

When a diagnostic arthroscopy turns surgical, you must turn to the surgical arthroscopy codes list in your CPT® book. If the scope is purely diagnostic in nature, you’ll choose a diagnostic knee arthroscopy code.

Confused? Don’t be. We’ve got an expert on board to talk us through the intricacies of diagnostic and surgical knee arthroscopies.

Dx Arthroscopy: The ‘Look Around Procedure’

When your provider performs a knee arthroscopy strictly to check the knee for injuries, it is a diagnostic arthroscopy. You’ll code these arthroscopies with 29870 (Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)), confirms Jennifer McNamara, CPC, CRC, CPC-I, CGSC, COPC, AAPC approved instructor and professional recruiter at Ozark Coding Alliance LLC in Bentonville, Arkansas.

“A scope procedure that is diagnostic is what I call the ‘look around procedure.’ The indications for this base procedure are to evaluate knee conditions like meniscus tears,” she explains.

The decision to perform the scope will likely stem from what the provider has already observed. Diagnostic arthroscopies are used to diagnose injuries further “based on the clinical indications they [providers] see on exam. Once they do the diagnostic procedure, they may see the need to perform a surgical arthroscopy to treat the condition during the same operative session,” explains McNamara.

Consider this example from McNamara:

The patient presents with left knee pain. On exam the patient exhibits knee pain and swelling. The physician orders a diagnostic knee arthroscopy to confirm the reason. During the diagnostic procedure, the surgeon decided to perform a synovial biopsy to in order to investigate the inflammatory condition and left knee effusion. The provider performs no further actions during the scope.

For this claim, you’d report:

• 29870 for the arthroscopy
• Modifier LT (Left side) appended to 29870 to indicate laterality
• M25.462 (Effusion, left knee) appended to 29870 to represent the patient’s knee swelling
• M25.562 (Pain in left knee) appended to 29870 to represent the patient’s knee pain.

When Arthroscopy Goes Surgical, Look to Other Codes

The provider might also opt to perform a surgical knee arthroscopy, in which case 29870 is off the table. For these encounters, you’ll need to choose a code from the 29871 (Arthroscopy, knee, surgical; for infection, lavage and drainage) through 29887 (… drilling for intact osteochondritis dissecans lesion with internal fixation) code set. There are around 15 surgical knee arthroscopy codes, so pay attention when you choose the code. Some of the surgical procedures your provider might perform during a knee arthroscopy include:

• Lateral release
• Removal of loose or foreign body (FB)
• Synovectomy
• Debridement or shaving of articular cartilage
• Meniscus repair
• Drilling for osteochondritis.

Consider these two examples of surgical knee arthroscopy from McNamara:

Example 1: The patient fell and heard a pop in their left knee. On examination they had a positive McMurray test. After a diagnostic arthroscopy is performed, a complex meniscus tear is found in the lateral compartment of the left knee. The surgical arthroscopy is performed with a lateral meniscectomy and shaving of the articular cartilage in the lateral compartment on the left knee.

For this claim, you’ll report 29881 (… with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed) with modifier LT appended. Also, attach S83.272A (Complex tear of lateral meniscus, current injury, left knee, initial encounter) to 29881.

Example 2: The provider examines the patient’s knee via the diagnostic knee scope; they note a meniscus tear. “Depending on the compartment of the knee and the extent of the injury, the physician may either perform a meniscectomy or a meniscus repair,” explains McNamara. “In a meniscectomy, the physician will remove the meniscus or trim the damaged tissue and perform a chondroplasty or debridement. If they need to perform a repair they will use sutures and anchor the meniscus to accomplish the repair.”

If the provider performed a meniscectomy, you’ll report either 29880 (… with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/ shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed) or 29881 (… with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed), depending on encounter specifics. If the provider performs meniscus repair, report either 29882 (… with meniscus repair (medial OR lateral)) or 29883 (… with meniscus repair (medial AND lateral)), depending on encounter specifics.

Coding Dx and Surgical Scope on Same Claim? Not so Fast …

If the provider starts out performing a diagnostic knee arthroscopy and then decides to perform a repair on the same knee during the arthroscopy, you cannot report 29870. Once the arthroscopy becomes surgical, you must choose a code from the 29871 through 29887 code set.

The only way you could report a diagnostic and surgical knee arthroscopy on the same claim is if the procedures were performed on separate knees. For example, a patient that has suffered multiple traumas from a motor vehicle accident has injured both knees. The surgeon performs a diagnostic arthroscopy on the right knee, and abrasion arthroplasty on the patient’s left knee.

On this claim, you’ll report 29879 (… abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture) with modifier RT appended for the surgical arthroplasty; and 29870 with modifier LT appended for the diagnostic arthroplasty. (Always report the code with higher relative value units (RVUs) first on a claim.)