Orthopedic Coding Alert

Question: After a level-three new patient office/outpatient evaluation and management (E/M) service, the orthopedist performs an arthroscopy with meniscectomy and a chondroplasty on a patient’s left knee. How should I proceed with the claim? Can I report codes for the E/M, the meniscectomy, and the chondroplasty?

Tennessee Subscriber

Answer: You’ll be able to report an E/M and a meniscectomy code, but you won’t be able to code for the chondroplasty. On the claim, report:

• 29880 (Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed) or 29881 (… with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed) for the arthroscopy and meniscectomy, depending on encounter specifics.
• Modifier LT (Left side) appended to 29880 or 29881 to indicate laterality, if the payer requires it.
• 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity …) for the E/M.
• Modifier 57 (Decision for surgery) appended to 99213 to show that the E/M led to the surgical procedure.

Explanation: There is a code for chondroplasty, 29877 (Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)). However, you cannot report 29877 along with a medial/lateral meniscectomy on the same knee during the same session. In fact, under the CPT^® descriptor for 29877, CPT^® reports: “When performed with arthroscopic meniscectomy, see 29880 or 29881.”