Orthopedic Coding Alert

Do you know how the provider decided the patient needed arthroscopy?

When a patient has a knee arthroscopy, knowing the procedure and anatomy are only the beginning of your coding journey.

You’ll also need to know how the surgeon assessed the patient and decided to perform arthroscopy. Also, you’ll need to know what type of knee arthroscopy the physician performed—and there are a lot of codes to choose from for these surgeries.

Check out this expert advice on coding for knee arthroscopies.

Imaging Is Often the Beginning of Tx

When a physician is deciding whether or not the patient needs a knee arthroscopy, they could take several routes, explains Angela Clements, CPC, CPMA, CEMC, CGSC, COSC, CCS, AAPC Approved Instructor, physician coding auditor/ educator consultant at MedKoder, LLC in Mandeville, Louisiana.

“It depends on the patient’s condition or complaint that they present with. Sometimes a patient will come in to the office and they will perform X-rays and a knee examination and determine an MRI is needed; following those results, it is determined a patient needs to have a scope to repair a meniscus or ACL,” she says.

On other occasions, the physician will order X-rays; physical therapy (PT); over-the-counter or prescribed medication; and/ or joint injections. If the conservative treatments fail, the physician will order an MRI where the results may determine a scope is needed, explains Clements.

Imaging codes: When your surgeon orders an X-ray or MRI for a patient who might need a knee arthroscopy, choose from the following codes, depending on encounter specifics:

• 73560 (Radiologic examination, knee; 1 or 2 views)
• 73562 (… 3 views)
• 73564 (… complete, 4 or more views)
• 73565 (… both knees, standing, anteroposterior)
• 73580 (Radiologic examination, knee, arthrography, radiological supervision and interpretation)
• 73721 (Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material)
• 73722 (… with contrast material(s))
• 73723 (… without contrast material(s), followed by contrast material(s) and further sequences)

Separate E/M Codeable in Most Cases

The decision to order X-rays, PT, medications, or joint injections will take place during an evaluation and management (E/M) service. You’ll most likely code this E/M with a code from the 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/ or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.) code set, depending on encounter specifics — but if the encounter occurs at a facility, you’ll choose from the hospital E/M codes (observation, inpatient, consultation, emergency department (ED), etc.).

“There is typically a codeable E/M prior to the decision to perform knee arthroscopy,” confirms Jessyka Burke, BHSA, CPC, COSC, CASCC, coding specialist at Cascade Orthopaedics in Auburn Washington. “The provider will have to evaluate the patient; order imaging if this hasn’t been done; review imaging; go over risks benefits, and treatments that have been tried and failed; and then make the ultimate decision for surgery, and which surgery will be the best option for the patient.”

Clements agrees that there is usually a codeable E/M prior to a knee arthroscopy “as long as the provider documents the medical necessity of the visit. What is not reimbursable is when a decision for surgery is made and the patient is brought back to the clinic to sign consents, answer any additional questions, and perform the hospital required H&P [history and physical exam] service,” according to Clements.

Report These Codes for Knee Arthroscopies

There are several codes to choose from when reporting a knee arthroscopy. Knowing what each code represents is vital to securing rightful reimbursement for each encounter.

Diagnostic: If the surgeon performs a diagnostic knee arthroscopy, report 29870 (Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)). You’ll report this when the surgeon checks the knee out but opts against surgery. “It’s basically just a looksee and possibly a biopsy,” relays Clements.

Surgical 1: If the surgeon decides to make the arthroscopy surgical, there are more than 10 surgical codes to choose from. The codes are in the 29871 (Arthroscopy, knee, surgical; for infection, lavage and drainage) through 29887 (… drilling for intact osteochondritis dissecans lesion with internal fixation) code set; check your CPT resources for more information on the codes’ specifics.

Surgical 2: There’s a couple more knee arthroscopy codes that could give you pause when you see them at the end of the knee arthroscopy code set:

• 29866 (Arthroscopy, knee, surgical; osteochondral autograft(s) (eg, mosaicplasty) (includes harvesting of the autograft[s]))
• 29867 (… osteochondral allograft (eg, mosaicplasty))
• 29868 (… meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateral)

“CPT^® codes 29886 and 29867 are specifically for osteochondral autograft/allograft arthroscopic surgeries and 29868 is for meniscal transplantation done arthroscopically,” Burke explains. This procedure may also have an open (arthrotomy) component as indicated in the code description.