Coding & Billing

Financial Management

By: Deborah Laubach

Published: 12/6/2009

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Compartmentalizing Knee Arthroscopy Cases


It's all about compartments when it comes to coding arthroscopic knee procedures. You must bundle procedures performed in the same compartment — meaning that you may report only the single highest-level procedure — but you can report multiple CPT codes when your surgeons do work in separate compartments. Making this distinction is the key to picking up all of the codes possible when coding knee procedures (see "5 Knee Arthroscopy Coding & Billing Tips" on page 21). Your surgeons can greatly assist you in maximizing reimbursement by dictating with compartments in mind. For example, your surgeons can dictate a separate paragraph for each compartment, stating what they saw and what they did in the medial compartment, the lateral compartment and so on.

Anatomy lesson
To understand compartments, we first must understand some knee anatomy:

  • Medial compartment. The area between the femur and tibia on the "inside" of the knee.
  • Lateral compartment. The area between the femur and tibia on the "outside" of the knee.
  • Patellofemoral compartment. The area between the undersurface of the patella and the femur.
  • Intra-articular notch. Contains the ACL and PCL, but is not considered a separate compartment for coding purposes.

5 Knee Arthroscopy Coding & Billing Tips

  • You can code procedures performed in each compartment separately — with 2 notable exceptions: major synovectomy (29876) and meniscus repair (29882). You must bundle these even if they're performed in different compartments.
  • Use the -59 modifier (distinct procedural service) for each subsequent procedure code.
  • Medicare rules specify the use of HCPCS G0289 to report a chondroplasty performed with another arthroscopic knee procedure. If your surgeons are performing "thermal chondroplasty," that's not the same procedure as chondroplasty (29877). It's a wise idea to validate coverage and coding (unlisted code 29999, for example) with your local payors.
  • Arthroscopic knee procedures may include a number of high-cost items. You're likely to get the best price on these items if you use a single vendor. Some examples: Arthroscopic systems typically use such disposable attachments as burs, blades and shavers, which may be individual components or part of a kit. Fixation work is generally performed with screws, so get an accurate count of the number used. Anchors are particularly expensive.
  • Be sure to capture drugs and supplies used in the recovery room. If you send patients home with a polar care unit, bill for the pad and the cooler. If you administer a post-op pain block, capture the procedure, the drug and the needle.

— Deborah Laubach, MBA, CPC, CPC-H

A review of CPT codes
Arthroscopic knee procedure CPT codes range from 29866 to 29889. CPT codes are grouped into 6 sections:

1. Mosaicplasty. Resurfacing technique consisting of transplantation of multiple osteochondral grafts to smooth the area.

  • 29866 is for autografts (from the patient).
  • 29867 is for allografts (tissue from the same species, but different genetic background).

2. Meniscal transplantation, medial or lateral (29868). Removal of the damaged portion of meniscus, creation of tibial tunnels or bone trough, and insertion and securing of meniscal graft.

3. Diagnostic arthroscopy (29870) — with or without biopsy. Note that this is always bundled if combined with a surgical procedure.

4. Surgical arthroscopy lavage & drainage (29871). Irrigation/ washing out.

5. Surgical arthroscopy (major section 29873 to 29887).

  • 29873. With lateral release. To relieve chondromalacia patella, or "runner's knee."
  • 29874. Removal of loose/foreign body using a grasper or shaver.
  • 29875. Limited synovectomy. Removal of plica or shelf using a shaver.
  • 29876. Major synovectomy. Removal in 2 or more compartments.
  • 29877. Chondroplasty. Debridement/shaving of articular cartilage.
  • 29879. Abrasion arthroplasty, may include chondroplasty. A bur is used to remove dead bone in order to activate blood vessels and induce scab formation and subsequent healing of the articular cartilage.
  • 29880. Medial and lateral meniscectomy (partial or total resection of the meniscus), including meniscal shaving.
  • 29881. Medial or lateral meniscectomy, including meniscal shaving.
  • 29882. Medial or lateral meniscus repair (an additional incision is made on the side of the knee to pass sutures through the meniscal cartilage tear and then knotted to secure).
  • 29883. Medial and lateral meniscus repair.
  • 29884. Lysis of adhesions. Cutting and removal of scar tissue and possible subsequent manipulation.
  • 29885. Osteochondritis dessicans. Drilling, with bone grafting, with or without internal fixation.
  • 29886. Osteochondritis dessicans. Drilling for intact lesion. Drilling only, no bone grafting or fixation.
  • 29887. Osteochondritis dessicans. Drilling for intact lesion, with internal fixation, no bone grafting.

6. ACL (29888) or PCL (29889)

  • Repair. Sutures, staples or anchors are placed into the injured ligament.
  • Augmentation. Repair, plus a hamstring tendon is placed for additional support.
  • Reconstruction. The injured ligament pieces are removed and replaced with a patellar or hamstring tendon (autograft), allograft or synthetic ligament.

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