Orthopedic Coding Alert

Question: Can I submit codes for an elbow arthroscopy and an elbow arthrotomy during the same session? What about a pre-procedure evaluation and management service; is that separately codeable?

Can I submit a code for each surgical procedure, or is one bundled into the other?

Nebraska Subscriber

Answer: Elbow arthrotomy and arthroscopy are not bundled into each other; you can report each code separately if the provider performs both procedures. You will likely need help from a modifier (or two), too.

Caveat: You need to know more about the elbow pathology your provider is treating before you can decide what specific code(s) to choose. We can, however, provide a general overview of arthroscopy/arthrotomy coding.

Arthrotomy Coding

You’ll choose from one of the following arthrotomy codes, depending on encounter specifics:

• 24000 — Arthrotomy, elbow, including exploration, drainage, or removal of foreign body
• 24006 —Arthrotomy of the elbow, with capsular excision for capsular release (separate procedure)
• 24100 — Arthrotomy, elbow; with synovial biopsy only
• 24101 — … with joint exploration, with or without biopsy, with or without removal of loose or foreign body
• 24102 — … with synovectomy.

Modifier: Append modifier LT (Left side) or RT (Right side) appended to the arthrotomy code you choose to indicate laterality, if the payer requires it.

Arthroscopy Coding

You’ll choose from one of the following arthroscopy codes, depending on encounter specifics:

• 29834 — Arthroscopy, elbow, surgical; with removal of loose body or foreign body
• 29835 — … synovectomy, partial
• 29836 — … synovectomy, complete
• 29837 — … debridement, limited
• 29838 — … debridement, extensive.

Modifier 1: Append modifier 51 (Multiple procedures) to the arthroscopy code to show that your claim includes multiple procedure codes. According to the CPT® 2019 manual descriptor for the Endoscopy/Arthroscopy set of codes: “When arthroscopy is performed in conjunction with arthrotomy, add modifier 51.”

Modifier 2: Append modifier LT (Left side) or RT (Right side) to the arthroscopy code you choose to indicate laterality, if the payer requires it.

E/M Coding

You can report a separate E/M service code with the procedure codes if you can find evidence of significant, separately identifiable service prior to the surgeries — not just the standard pre-procedure services.

Modifier: If you do report a separate E/M from the 99201 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making … ) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity … ) set, append modifier 57 (Decision for surgery) to the to show that the E/M service was separate from the surgical procedures.

Since all of the surgical codes you are choosing from have major (90-day) global periods, you won’t have to worry about appending modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to any of the arthrotomy/arthroscopy codes in this instance.