Ins and Outs of Knee Coding

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Ins and Outs of Knee Coding
Presented By Trenda Davis, CPC Auditor
SuperCoder.com
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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 CodingSynovectomy

• 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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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.
Example A
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CPT Ðode 2???5 ÐaYt de reported with aYy other
arthrosÐopiÐ kYee procedure on the same knee in
the same session. You can only bill 29881.
Rationale
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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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This example shows the provider performed major
synovectomy due to inflamed synovium. Provider
can bill 29881 and 29876.
Rationale
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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 CodingCPT 29877

• CPT code 29877
• separate compartment
• bill only once per session

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Arthroscopic CodingCPT 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 CodingG0289

• 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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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.
Rationale
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Arthroscopic CodingCPT 29879
29879 abrasion arthroplasty (includes
chondroplasty where necessary) or multiple
drilling or microfracture. DoÐuweYtatioY should
state ?microfracturing and/or debriding dowY to
dleediYg doYe to prowote healiYg?
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Arthroscopic CodingCPT 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 CodingCPT 29888

• Diagnosis codes for revision
• Z47.2 (Encounterfor 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 CodingCPT 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 CodingMeniscectomy 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 CodingAcute 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 CodingAcute 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 codingAcute 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 CodingAcute 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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