Orthopedic Coding Alert

Question: According to my orthopedist's op note, the patient underwent a medial meniscal repair with debridement of synovitis in the notch and lateral regions and patella femoral synovitis resection. The op note wording, however, is what is throwing me off. Should I: A) bill 29882 with 29877 (G0289) x 2 for the synovitis debridement in the notch and lateral regions and 29875 for the patellofemoral resection, or B) only bill 29882 and 29876-59 because the orthopedist did the synovectomies in two or more compartments?

California Subscriber

Answer: Choose B. You should most likely report 29882 (Arthroscopy, knee, surgical; with meniscus repair [medial OR lateral]) for the medial meniscal repair or medial compartment. For the patellofemoral resection and lateral compartments, you should report 29876 (Arthroscopy, knee, surgical; synovectomy, major, two or more compartments [e.g., medial or lateral]) with modifier 59 (Distinct procedural service).

Rationale: Your B option is mostly correct because it is for major synovectomy (two or more compartments), but you can't use the medial compartment. The reason is that the orthopedist did a meniscal repair there (one compartment). To report 29876 in addition to 29882, your orthopedist must perform the synovectomies in different knee compartments.

Good advice: Take advantage of Box 19 to explain the additional compartments, with your ICD-9 code for 29882 being specific to the medial compartment. For instance, you might link 719.06 (Effusion of joint; lower leg) to 29876, and link 717.5 (Internal derangement of knee; derangement of mensicus, not elsewhere classified) to 29882.

Your A option is incorrect because 29877 (Arthroscopy, knee, surgical; debridement/shaving of articular cartilage [chondroplasty]) is a chrondoplasty, not a synovectomy.