Orthopedic Coding Alert

Question: How should I code the following procedure?

Arthroscopy of the right knee;

Anterior cruciate ligament (ACL) reconstruction right knee with patellar tendon bone graft using endoscopic technique;

Partial medial meniscectomy anterior horn right knee;

Partial chondroplasty of the medial femoral condyle right knee.

Would all of this be bundled into the ACL repair?

South Carolina Subscriber

Answer: Some of the items you describe are bundled procedures while others are not. You can bill for the arthroscopic ACL repair using 29888 (arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction) and the meniscectomy using 29881 (arthroscopy, knee, surgical; with meniscectomy [medial OR lateral, including any meniscal shaving]), but use modifier -51 (multiple procedures). A meniscectomy is not included in an ACL reconstruction, so you should not have any problem with carrier bundling. However, a chondroplasty should not be reported in addition to a meniscectomy when both procedures are performed in the same compartment of the knee; therefore, in this case 29877 (arthroscopy, knee, surgical; debridement/shaving of articular cartilage [chondroplasty]) should not be reported. The diagnostic arthroscopy (29870) also should not be reported because CPT states that a diagnostic arthroscopy is always included in a surgical arthroscopy.