Knee arthroscopy is an effective and frequently used tool for diagnosing knee conditions such as meniscus tears and cartilage wear. Orthopedic surgeons and their medical coding service providers need to understand the different types of CPT codes involved as well as Medicare’s National Correct Coding Initiative (NCCI) guidelines, procedure-to-procedure edits, and private payer guidelines to report services correctly and ensure maximum reimbursement.
Knee arthroscopy involves using a fiber optic endoscope to visualize the joint space of the knee. This allows the surgeon to perform arthroscopic surgery using instruments inserted through small incisions, rather than having to perform an open procedure. Here are the essentials of knee arthroscopy coding as explained by AAPC:
- Meniscectomy and Meniscal Repair
The three major components of the knee – medial, lateral and patellofemoral – are a key consideration in reporting meniscectomy and meniscal repair.CPT®, AAOS, and Medicare all recognize these three compartments in the knee. The relevant CPT codes are as follows:
Meniscectomy (29880 and 29881)involves surgery to remove of all or part of a torn meniscus.
29880 Arthroscopy, knee, surgical; with meniscectomy (medial and lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed
29881 …with meniscectomy (medial or lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed
The codes to use when the meniscal tear is repairable are:
29882 with meniscus repair (medial or lateral)
29883 with meniscus repair (medial and lateral)
Meniscectomy and Meniscal Repair – Points to note:
- Generally, meniscectomy and meniscal repairs are the primary service and may be performed alone or with other services.
- A second procedure may be reported if performed in a separate compartment, but not if it is performed in the same compartment.
- CPT definitions and GSD and NCCI guidelines for payment are based on whether meniscal or other procedures are performed in one or multiple compartments.
- Meniscal repair codes do not include chondroplasty.
29877 Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)
CPT and GSD rules for reporting 29877 differ from those of Medicare.
- According to CPT, arthroscopic chondroplasty in the medial, lateral, and/or patellofemoral compartment(s) may be reported once per surgical session with other arthroscopic procedures when performed in a separate compartment – excluding meniscectomy procedures.
- GSD guidelines also state that chondroplasty is separately reportable with other procedures when performed in a separate compartment where no other surgical procedure is performed, and when it is not included in the primary code by definition.
Based on CPT and GSD rules, modifier 59 may be appended to indicate chondroplasty was performed as the only procedure in a separate compartment.
- Medicare instructs providers to use of HCPCS Level II code G0289 Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chrondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee, instead of 29877, to report chondroplasty when it’s performed in a separate compartment.
- Chondroplasty is not reportable with meniscal repairs to CMS or any other payer.
- Though G0289 was created for reporting on Medicare claims, some non-Medicare payers have adopted it.
Chondroplasty – Points to note:
- Neither 29877 nor G0289 should be used to report chondroplasty with meniscectomy 29880 or 29881 since chondroplasty is included in their definitions.
- Chondroplasty (29877 or G0289) may be separately reported with meniscal repair codes 29882 and 29883 when performed in a separate compartment, as long as another reportable service is not performed there.
- Modifier 59 is not used for Medicare claims. Medicare assumes that G0289 represents the arthroscopic removal of a loose body or foreign body in a different compartment.
- Modifier 59 may be applied when reporting 29877 to private payers to indicate the separate compartment rule is met.
- For non-Medicare patients: 29874 may be reported with a primary service such as meniscectomy or meniscal repair (even from within the same compartment).
Modifier 59 should be used to indicate the size or separate incision criteria are met.
- For Medicare patients: 29874 should be reported only when it is the sole procedure performed. G0289 includes the reference “in a different compartment of the same knee”. Therefore, loose or foreign body removal performed in the same compartment as another procedure should not be reported, even if the size and incision criteria are met.
- CPT: If pathologic synovial disease is present, 29876 may be reported with another arthroscopic knee procedure, even if it occurs in the same compartment – excluding procedures for removal of loose/foreign body or chondroplasty.
- Medicare: In addition to requiring medical necessity of pathologic synovial disease, Medicare requires that 29876 is reported only if no other arthroscopic surgery is performed in the same compartment.
- Lateral/Retinacular Release
29873 Arthroscopy, knee, surgical; with lateral release
- Medicare: Medicare requires G0289 to report either the chondroplasty or loose/foreign body removal when performed with 29873, and to meet the separate compartment criterion.
- CPT: To report 29873, chondroplasty must be performed in a separate compartment.
- Lysis of Adhesions
29884 Arthroscopy, knee, surgical; with lysis of adhesions, with or without manipulation (separate procedure)
- For both Medicare and non-Medicare claims, arthroscopic lysis of adhesions should not be reported with any other arthroscopic procedure in the same knee as it a “separate procedure.”
Removal of Loose or Foreign Bodies
29874 Arthroscopy, knee, surgical; for removal of loose body or foreign body
29875 Arthroscopy, knee, surgical; synovectomy, limited (separate procedure)
CPT defines limited synovectomy as a “separate procedure.” Therefore, 29875 should be reported when it is the only arthroscopic procedure performed on that knee. Compartments are not significant for reporting this CPT code.
29876 Arthroscopy, knee, surgical; synovectomy, major, 2 or more compartments
For reporting 29876 in addition to another arthroscopic knee procedure, documentation must provide evidence of pathologic synovial disease. CPT and Medicare have different rules for reporting this service:
With these complex payer guidelines, outsourcing medical billing and coding to an experienced service provider could be the ideal option to ensure accurate reporting of knee arthroscopy.