Wiki Arthroscopic Meniscectomy & ACL Debridement

[MI_CODER]

Hello,

I need another coder's opinion. My doctor is performing an arthroscopic meniscectomy and an ACL debridement. According to the information I found, I would want to use an unlisted code (29999) for the ACL debridement. My question is would it even be appropriate to be coding for the ACL debridement since 29880/29881 includes debridement in the same or separate compartments?

Thank you in advance.

 

[AlanPechacek]

Without seeing the Operative Report, this is hard to answer. Coding for the ACL portion of the procedure could depend on several factors such as the the Acuteness vs the "Chronicness" of the ACL injury, its appearance/condition (other than being torn) at the time, the amount of time and attention spent in debriding it, whether the ACL injury was a substantive part of the patient's clinical problem and preoperative planning (such as was this part of a staged procedure with the intention to do an ACL reconstruction in the future rather than at this setting?), i.e. Documentation, Documentation, Documentation. If it were a chronic, known condition for which there was no apparent plan for future treatment/reconstruction, and its removal was "incidental," then I don't think it should be coded and charged for separately. If it were a big issue/element of the patient's knee problem, i.e. clinically significant, then its removal could be considered a separate/additional procedure, but I would not use the Unlisted Procedure Code, but use 29875: Limited Synovectomy with Modifier 51, instead. Technically/anatomically, the ACL and the PCL are not a part of either the medial or lateral compartments, but are in the femoral notch and tibial spine portion of the joint.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com

 

[MI_CODER]

I agree and your explanation makes sense. Below is an example of how I'm seeing these ACL debridements being documented. Based on your opinion, I'm thinking these debridements shouldn't be separately coded because they seem like they're incidental. These patients are coming in for knee pain and being diagnosed with a meniscal tear which then prompts them to do the arthroscopy. At that point is when they find the ACL tear.

Medial and lateral arthrotomies were performed. This is an arthroscopic procedure. Patient was found to have C3-C4 chondromalacia of the patellofemoral joint. Chondroplasty of the patellofemoral joint was performed. Medial gutter was then swept. No evidence of loose bodies. The medial joint space was entered. The patient was found to have C3-C4 chondromalacia of the medial femoral condyle, medial tibial plateau. Chondroplasty of the medial femoral condyle and medial tibial plateau was performed. Patient also had a tear of the posterior horn of the medial meniscus. Partial medial meniscectomy was performed. ACL was partially torn. Patient had debridement of the ACL, lateral joint space was entered. Patient had a partial tear of the lateral meniscus, partial lateral meniscectomy was performed. Patient also had C2-C3 chondromalacia of the lateral femoral condyle, lateral tibial plateau. Chondroplasty of the lateral femoral condyle and lateral tibial plateau was performed, lateral gutter was then swept, no evidence of any loose bodies. Patient tolerated the procedure well. There were no complications.