Orthopedic Coding Alert

Question: While our orthopedist was performing an arthroscopic partial meniscectomy (29881), he diagnosed chondromalacia (717.7) but left the diseased cartilage untouched. Six weeks later, the patient presented with an inflamed knee due to the chondromalacia, and the orthopedist administered a cortisone injection. Can we report the injection separately, or is it bundled into the global surgical period?

New York Subscriber

Answer: You should link the torn meniscus diagnosis code (836.0-836.2) to 29881 (Arthroscopy, knee, surgical; with meniscectomy [medial OR lateral, including any meniscal shaving]) and link the injection code (20610*, Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]) to 717.7. The separate diagnoses will show the insurer that both procedures were medically necessary. To ensure payment, you should append modifier -79 (Unrelated procedure or service by the same physician during the postoperative period) to 20610.