Orthopedic Coding Alert

Question: My orthopedist performed a medial and lateral meniscectomy on a patient, and also performed a synovectomy in the patellofemoral compartment. Since the arthroscopic procedures were performed in separate knee compartments, is it possible to code for either procedures, or do I have to choose one?

Mississippi Subscriber

Answer: You should be able to report both procedures. On the claim, report the following:

• 29880 (Arthroscopy, knee, surgical; with meniscectomy [medial AND lateral, including any meniscal shaving])
• 29875 (... synovectomy, limited [e.g., plica or shelf resection [separate procedure]]) for the synovectomy
• modifier 59 (Distinct procedural service) appended to 29875 to show that the synovectomy and meniscectomy were separate services.

Explanation: In case the payer challenges the correctness of this coding, note this guidance from the August 2001 CPT Assistant: "Arthroscopic synovectomy is reported using codes 29875 and 29876.

Limited synovectomy (29875) involves resection of the synovium and may include partial resection of the plica of one knee compartment. ...

"Code 29875 is designated as a "separate procedure." Codes with the "separate procedure" designation normally would not be additionally reported when the procedure or service is performed as an integral component of another procedure or service.

However, when a procedure or service designated as a separate procedure is carried out independently or is considered unrelated or distinct from the other procedure(s) or service(s) provided at that time, then it would be appropriate to report the code in conjunction with the other procedure(s) or service(s).

"Modifier -59, Distinct Procedural Service, should be appended to the separate procedure code to indicate that the procedure was distinct from the overall procedure. For example, if the knee arthroscopy with limited synovectomy were performed in a different knee compartment than another knee procedure, modifier - 59 would be appended to code 29875 to indicate that a different compartment was involved."