Here are simple pearls and pointers for coding some of your more complicated cases.

End the confusion of synovectomy coding
One of the biggest challenges in coding knee arthroscopies is determining whether to select CPT code 29875, arthroscopic synovectomy, limited, or 29876, arthroscopic synovectomy, major, two or more compartments. Here are three points to keep in mind to accurately report an arthroscopy of the knee:

• Select the code by the description of the operative procedure, not by the title of the operative report.
• Recognize that for coding purposes, there are three compartments of the knee: patellofemoral, lateral and medial.
• When reading and abstracting information from the operative report, follow the surgeon as he describes the procedures performed within each of these three compartments. Look at each compartment, then determine the overall code(s) for each individual compartment.

Let's say a surgeon does a synovectomy of the medial compartment. You'd initially select 29875 for that compartment. If he also performs a meniscectomy of the medial compartment, you'd select 29881 for the medial compartment, resulting in two code selections for that one compartment. But because 29875 bundles into 29881, you'd only report 29881 for the medial compartment.

Now let's say that the surgeon then performs a synovectomy of the patellofemoral compartment without performing any additional procedures in that compartment. Since your focus is reporting work performed specifically in the patellofemoral compartment, you'd select 29875 for that compartment.

In the lateral compartment, the surgeon performs a synovectomy, 29875, and a meniscectomy, 29881. Since your focus is on work performed in the lateral compartment, you'd select 29875, which bundles into 29881. So you'd only report 29881 for the lateral compartment.

Since there is a CPT code that describes a medial and lateral meniscectomy, let's now convert our two preliminary code selections of 29881 for the medial and 29881 for the lateral compartments into the more comprehensive CPT code 29880, arthroscopic meniscectomy, medial and lateral. Our patellofemoral compartment code is 29875. Report CPT 29875 since it was performed in a separate compartment distinct from either the lateral or medial compartment.

To recap, you'd report these codes: 29880; 29875-59 (P = 29875; M 29881 L 29881 = 29880)

Had the surgeon performed only a synovectomy in the patellofemoral and medial compartments, you'd report CPT 29876 to reflect a two-compartmental synovectomy. Remember to verify reporting polices regarding knee arthroscopies with individual carriers.

Tenotomy or hammertoe?
When reporting hammertoe correction (interphalangeal fusion, partial or total phalangectomy, for example), are bone removal and fixation/fusion required to report CPT code 28285? Let's say you only perform a tenotomy to correct a hammertoe. Is it more appropriate to report tenotomy code 28232, flexor tenotomy, since this is a more specific procedural code, or should you report CPT 28285, correction of hammertoe, since the intent is to correct the hammertoe condition?

If the physician performs a flexor tenotomy as a means to correct a "contracture" condition of the toe, you'd report CPT code 28232, since it is specific for a tenotomy of the flexor tendon of the toe. Even if your surgeon states a "hammertoe" condition rather than a "contracture" condition, the AMA says the appropriate CPT code would still be 28232, since it's specific for a tenotomy of the flexor tendon of the toe.

A note regarding modifier usage: Individual carrier guidelines will determine the reporting of toe modifiers. Some carriers view these modifiers as HCPCS modifiers required for Medicare and not specifically CPT modifiers.

CPT advisors toss out tendon requirements
The musculoskeletal section of CPT seems to be the hardest hit when it comes to changes in coding guidelines. Specifically, the acute and chronic shoulder reconstruction code series appears to provide coders with many sleepless nights. Let's review a few codes from this CPT series:

• 23410 - Repair of ruptured musculotendinous cuff (rotator cuff, for example) open; acute
• 23412 - Repair of ruptured musculotendinous cuff (rotator cuff) open; chronic
• 23420 - Recon- struction of complete shoulder (rotator) cuff avulsion; chronic (includes acromioplasty)

CPT code 23410 differs from CPT codes 23412 and 23420 in that it describes an "acute" condition as opposed to a "chronic" condition. If the operative report describes an acute rotator cuff repair, it may be appropriate to report CPT 23410. Your challenge: determining whether to report CPT 23412 or CPT 23420, since both codes describe a chronic rotator cuff procedure.

Previous coding directives from the AMA stated that a specific number of tendons had to be torn to report 23420. To date, however, the AMA CPT advisors from both the American Academy of Orthopaedic Surgeons and the American Orthopaedic Association have indicated that a surgeon may report 23420 regardless of the number of torn tendons. Instead, the advisors say you should focus on whether your surgeon performed an acromioplasty.

The operative report should document whether the tear is chronic or acute, describe the type of repair and provide enough detail to accurately determine the appropriate CPT code.