Orthopedic Coding Alert

Question: What percentage of the meniscus must the surgeon remove before we should bill the meniscectomy code instead of the chondroplasty code? Also, our orthopedic surgeon performed a medial meniscectomy with lateral and patellar chondroplasties on a Medicare patient. Which codes should we report?

California Subscriber

Answer: Let's address your first question. The orthopedic surgeon does not need to document any particular percentage of meniscus removal to report the meniscectomy codes. The meniscectomy is a completely different procedure from chondroplasty. 

Op note hint: If the surgeon documents that he cleaned out a meniscal tear with an arthroscopic shaver, he performed a meniscectomy (29880-29881). If he documents that he cleaned out articular cartilage with the shaver, he instead probably performed chondroplasty. Even though the meniscus is considered -cartilage,- it is not the same type of cartilage as articular cartilage that is present at the end of bones. Anytime the physician removes meniscal tissue, you should consider it a meniscectomy.

As for your second question, you should report 29881 (Arthroscopy, knee, surgical; with meniscectomy [medial OR lateral, including any meniscal shaving]) once, followed by two units of G0289 (Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage [chondroplasty] at the time of other surgical knee arthroscopy in a different compartment of the same knee) to Medicare. 

Why: The surgeon performed meniscectomy in the medial compartment and performed the chondroplasty in the lateral and patellofemoral compartments.

Keep in mind: CPT states you can report a chondroplasty only one time, regardless of how many areas the surgeon addresses. Therefore, if your payer follows CPT guidelines, you would report 29881 and 29877-59 (Arthroscopy, knee, surgical; debridement/shaving of articular cartilage [chondroplasty]; Distinct procedural service).