Orthopedic Coding Alert

Question: My orthopedist documented the following: I introduced a probe through an anteromedial portal. The probing and partial medial meniscectomy (performed with punch shaver and electrocautery back to a stable rim) defined the extent of the medial meniscal tear. I aspirated several cartilaginous loose bodies through the scope and removed with the shaver. In order to better visualize the lateral compartment, I performed the wide debridement of the inflamed fat pad, ligamentum mucosum, synovium as well as the medial plica with shaver and electrocautery.Visualization of the lateral compartment then again showed that the lateral meniscus did not have a clinically significant tear. However, there was chondromalacia of the lateral tibial plateau. I performed an abrasion chondroplasty of the surface with shaver and electrocautery. My physician submitted 29879, 29881, and 29875, but I dont think this is right. What should I report?

Georgia Subscriber

Answer: You should report the medial meniscectomy with 29881 (Arthroscopy, knee, surgical; with meniscectomy [medial OR lateral, including any meniscal shaving]).

For the chondroplasty in the lateral compartment, you should report 29877-59 (Arthroscopy, knee, surgical; debridement/shaving of articular cartilage [chondroplasty]; Distinct procedural service) for a non-Medicare patient or 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) for a Medicare patient.

Notice the physician doesnt mention an abrasion chondroplasty being down to bleeding bone. The orthopedist is only debriding the chondral surface. So you should not report 29879 (Arthroscopy, knee, surgical; abrasion arthroplasty [includes chondroplasty where necessary] or multiple drilling or microfracture).

Also, the orthopedist performed the debridement of the fat pad, ligamentum mucosum, synovium, and medial plica for visualization. Therefore, this is not billable with 29875 (... synovectomy, limited [e.g.,plica or shelf resection] [separate procedure]).

Because the loose bodies are in the same compartment, you should consider the loose bodies as incidental to the meniscectomy.