Ins and Outs of Knee Coding

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

2. 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 2

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

4. Arthroscopic Coding Synovectomy • 29875- synovectomy, limited (plica or shelf reaction) (separate procedure) • 29876- Synovectomy, major, 2 or more compartments 4

5. Synovectomy-Approved Diagnosis • M06.869 - Other specified rheumatoid arthritis- unspecified knee • M05.069 - Felty’s 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 5

6. 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. 6

7. Rationale: CPT code 29875 can’t be reported with any other arthroscopic knee procedure on the same knee in the same session. You can only bill 29881. 7

8. 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. 8

9. Rationale: This example shows the provider performed major synovectomy due to inflamed synovium. Provider can bill 29881 and 29876. 9

10. 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. 10

11. Arthroscopic Coding CPT 29877 • CPT code 29877 - separate compartment - bill only once per session 11

12. 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. 12

13. 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. 13

14. 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. 14

15. 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. 15

16. 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” 16

17. 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 17

18. 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 (Ankylosisfor right or left knee) Code any bony deficit, adhesions, or other anatomical changes that lead to the increase complexity and increase your reimbursement. 18

19. Arthroscopic Coding CPT 29888 Can you bill all of these codes? 29888 – ACL Tear 29881 – Meniscectomy 29882,59 – Meniscus repair 19

20. 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. 20

21. Arthroscopic Coding Meniscectomyand 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) 21

22. 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 22

23. Diagnosis Coding Acute versus Chronic Diagnosis Exact location of the injury - Medial - Lateral Type of tear - Bucket Handle - Transverse - Torn Horn 23

24. 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 24

25. 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 25

26. 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. 26