In the "Grand Scheme of Things" as it relates to all the problems that occur in the knee joint resulting in Arthroscopic Surgery, Loose Bodies (M23.4 _) are generally a small part of it. Somewhere, somehow, somebody deemed that 1 cm. in diameter was a "magic" size. It implies that Loose Bodies smaller than this can't cause knee problems (pain, swelling, locking, catching, buckling, etc.). Any Loose Body that gets in the wrong place at the wrong time can cause trouble, mainly if it gets caught between the femur and tibia. Size should not necessarily be a determining factor as to coding for it as a diagnosis or for its procedural removal. The other factor is that they are truly "loose" and able to move around in the joint. Some are "loose" but are caught/trapped/hidden somewhere in the joint in such a way that they don't cause symptoms or problems. Other so-called "Loose Bodies" are not really "loose," but are attached/entrapped in the synovium, usually in the suprapatellar pouch. As such, they may not necessarily cause symptoms/problems. If at the time of Arthroscopy these are encountered, the surgeon may feel it advisable that they be removed. Personally, I didn't want to leave anything behind that might come back to haunt me or the patient. As for coding these "probably asymptomatic" "Loose Bodies" I think that the diagnosis for them should be listed in the Postoperative Diagnosis List, and the documentation in the Operative Report indicates that some extra time and surgical effort was required to free them from the synovium &/or scar tissue; and if large enough, required the enlargement of an Arthroscopy Wound/Portal or an Additional Incision to access and remove it/them. I am aware that a lot of Knee Arthroscopy procedural codes will "bundle" in the removal of "Loose Bodies" when encountered (NCCI Edits), and I would agree with this if they are removed by the flushing, continuous irrigation, and "vacuuming" of the joint that occurs in the course of the procedure for some other joint disorder. But if the documentation supports that they are truly "loose" in the joint and felt to be symptomatic, or fulfill the criteria above for the "not really loose" forms then I would try coding for their removal.
For what it is worth, this is my personal opinion based on my experience in Arthroscopy and coding. If the documentation supports it, go for it.
Respectfully submitted, Alan Pechacek, M.D.
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