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Ins and Outs of Knee

Coding
Presented By
Trenda Davis, CPC
Auditor; SuperCoder.com
Course Objectives
Discuss Arthroscopic coding of the Knee
Open Knee CPT Coding
Knee Arthroplasty
Ligament repair and reconstruction of the knee
Knee Fracture and Dislocation
Acute versus Chronic Diagnosis Coding

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3 Compartments of the Knee
Medial
Lateral
Patellofemoral/Suprapatellor/or
Anterior

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Arthroscopic Coding
Synovectomy
29875- synovectomy, limited (plica or shelf reaction) (separate
procedure)
29876- Synovectomy, major, 2 or more compartments

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Synovectomy-Approved Diagnosis
M06.869 - Other specified rheumatoid arthritis- unspecified knee
M05.069 - Feltys syndrome-unspecified knee
M08.069 Unspecified juvenile rheumatoid arthritis- unspecified
knee
M12.269 Villondular synovitis, unspecified knee
M25.869 Other specified joint disorder, unspecified knee

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Example A:
The patient has a lateral bucket-handle tear and synovitis. The surgeon
performs a lateral meniscectomy and medial compartment
synovectomy. The CPT code that should be reported is 29881.

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Rationale:
CPT code 29875 cant be reported with any other arthroscopic knee
procedure on the same knee in the same session. You can only bill
29881.

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Example B:
The patient has lateral anterior horn meniscus tear and synovial
chondromatosis. Surgeon performs a lateral meniscectomy and a tri-
compartment synovectomy to treat the inflamed synovium. The CPT
codes that should be reported are 29876 and 29881.

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Rationale:
This example shows the provider performed major synovectomy due to
inflamed synovium. Provider can bill 29881 and 29876.

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Arthroscopic Coding

29874 Arthroscopy, knee, for removal of loose body or foreign body.


29877- Arthroscopy, knee, debridement/shaving of articular
cartilage.
G0289 Arthroscopy for removal of loose body, foreign body,
debridement/shaving of articular cartilage at the time of other
surgical knee arthroscopy in a different compartment of the knee.

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Arthroscopic Coding
CPT 29877
CPT code 29877
- separate compartment
- bill only once per session

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Arthroscopic Coding
CPT 29874
CPT code 29874
- size of foreign/loose body (5mm or greater)
- separate compartment
- separate incision or portal

Check CCI edits, CPT code 29874 bundles with several other
arthroscopic procedure.

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Arthroscopic Coding
G0289
Code G0289
- size of foreign/loose body (5mm or greater)
- separate compartment
- separate incision or portal

Modifier -59 when need to used when billing G0289 to show the
procedure is distinct from other service provided on the same day.

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Example:
Patient is diagnosed with lateral meniscal posterior horn tear and
medial 5mm loose body. The surgeon performs a lateral meniscectomy
and medial loose body removal. The CPT codes that are reportable are
29881 and G0289-59.

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Rationale:
In this example, provider documented the size and compartment of the
loose body along with the meniscectomy. So it would be appropriate to
report 29881 and G0289-59.

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Arthroscopic Coding
CPT 29879
29879 abrasion arthroplasty (includes chondroplasty where
necessary) or multiple drilling or microfracture.

Documentation should state microfracturing and/or debriding


down to bleeding bone to promote healing

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Arthroscopic Coding
CPT 29888
CPT code 29888 Arthroscopic aided anterior cruciate ligament
repair or reconstruction
- Repair/reconstruction of ACL
Use CPT code 20924 only if graft if harvested from opposite leg.

- Revision of ACL
Modifier 22
29999 unlisted code

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Arthroscopic Coding
CPT 29888
Diagnosis codes for revision
Z47.2 (Encounter for removal of internal fixation device)
T84.116A or T84.117A ( Breakdown of internal fixation device of the right or
left lower leg, initial encounter)
Use these codes for the presence and removal of prior hardware.
M89.761 or M89.762 (Major osseous defect for right or left knee)
M24.661 or M24.662 (Ankylosis for right or left knee)
Code any bony deficit, adhesions, or other anatomical changes that lead to the
increase complexity and increase your reimbursement.

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Arthroscopic Coding
CPT 29888
Can you bill all of these codes?

29888 ACL Tear


29881 Meniscectomy
29882,59 Meniscus repair

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Example:
Patient has ACL tear with medial anterior meniscus tear and lateral
anterior meniscus tear. The surgeon does an ACL reconstruction,
medial meniscectomy and lateral meniscus repair. It would be
appropriate to report 29888, 29881, and 29882-59.

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Arthroscopic Coding
Meniscectomy and Meniscus Repair
29880 - Meniscectomy (medial and lateral)
29881 Meniscectomy (medial or lateral)
29882 Meniscus tear (medial or lateral)
29883 Meniscus tear (medial and lateral)
For and open Meniscus repair use CPT 27403 (Arthrotomy with
meniscus repair, knee)

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Diagnosis Coding
Acute versus Chronic Diagnosis
Acute recently occurred as a result of a traumatic event.
Chronic- Overuse or a long-standing condition.
Recurrent- tear in the same meniscus for a second time

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Diagnosis Coding
Acute versus Chronic Diagnosis
Exact location of the injury
- Medial
- Lateral
Type of tear
- Bucket Handle
- Transverse
- Torn Horn

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Diagnosis Coding
Acute versus Chronic Diagnosis
Chapter 13 Diseases of the Musculoskeletal System and Connective
Tissue
Chapter 19- Injury, Poisoning, and Certain Other Consequences of
External Causes

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Diagnosis coding
Acute versus Chronic Diagnosis
S83.219 Bucket-handle tear of medial meniscus, current injury,
unspecified
S83.239 Complex tear of medial meniscus, current injury, unspecified
S83.259 Bucket-handle tear of lateral meniscus, current injury,
unspecified

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Diagnosis Coding
Acute versus Chronic Diagnosis
M23.219 Derangement of anterior horn of medial meniscus due to
old tear or injury
M23.229 Derangement of posterior horn of medial meniscus due to
old tear or injury
M23.249 Derangement of anterior horn of lateral meniscus due to
old tear or injury
M23.259 Derangement of posterior horn of lateral meniscus due to
old tear or injury.

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