chondroplasty vs abrasion chondroplasty

[lchiriac]

We are having a debate in the office in deciding if the op report documentation as of " There was a 5 mm region of focal grade 3-4 chondromalacia. Shaver was used to perform abrasion chondroplasty down to bleeding bone" will be enough documentation to support 29879 instead of 29877. Thank you

 

[amyjph]

What do the op notes for 29877 say?

Also, depends on if they are trying to say it on every one to unbundle the "regular old" chondroplasty from other scope in the same knee/same time. I am not a surgeon or clinician, however, not sure "5 mm region of focal grade 3-4 chondromalacia. " is going to cut it for 29879. Sounds like 29877 to me. Did the provider suddenly change the way they dictate or start adding this to every op note?

This statement has the abrasion chondroplasty word, and bleeding bone, so probably enough. However, I might be looking for different instruments to be called out, not just shaver. (burr, drill, or microfracture pick/awl)
I think it depends, I would have to see what else was done, the entire op note, and if this was suddenly called out in every single case differing from prior notes. And, if you got a different or new EMR/EHR/dictation or AI driven coding/dictation software.

https://www.beckersspine.com/uncate...oding-pitfalls-impacting-an-ascs-bottom-line/ (old but talks about it)

 

[lchiriac]

Thank you, it is pretty common documentation for same type of procedures and that's why the debate started. Codes chosen (29879, 29876, 29881). Please see below complete op report.

Procedure In Detail: On the day of surgery, the patient was seen in the preoperative holding area. Consent was reviewed and questions were answered. Site verification was performed and the upper extremity was marked. The patient was taken to OR and transferred on to the table. She underwent general anesthesia. All bony prominences were padded. She received 2 g of Ancef. A tourniquet was applied to the operative limb and SCD was applied to the nonoperative limb. The patient was prepped and draped in the usual sterile fashion. A surgical time-out was performed. The limb was exsanguinated with an Esmarch bandage and tourniquet was inflated to 250 mmHg.

Standard anterolateral and anteromedial arthroscopic portals were made with an 11 blade. A diagnostic arthroscopy was performed. There was grade 1 chondromalacia in the patellofemoral joint. There was extensive synovitis. The shaver was used to debride the erythematous synovium. The medial and lateral gutters had loose bodies. We then entered medial compartment. There was grade 1 chondromalacia. The medial meniscus was probed and found to be intact. There was synovitis present. The erythematous synovium was debrided with a shaver. We then entered the notch. The ACL and PCL were intact. We then entered the lateral compartment. There was a discoid lateral meniscus present that was completely torn along the entire periphery of the meniscus. A combination of biters and shavers were used to debride the torn meniscus. This ended up being a near-total meniscectomy as her age precluded successful repair. There was a 5 mm region of focal grade 3-4 chondromalacia. Shaver was used to perform abrasion chondroplasty down to bleeding bone. This concluded the procedure. The arthroscope was removed. The portals were closed with 3-0 nylon sutures. Sterile dressing was applied. The drapes were taken down. Tourniquet was deflated. The patient was extubated, transferred to gurney. She was taken to PACU in stable condition.

Thank you for your time and ffedback.

 

[amyjph]

I am seeing 29881 supported. *maybe* 29879 but pretty weak documentation... I probably would not if it were me coding it. Or I would send it back for query.
What does the header say? Surgical in/out time?
You can also check AAOS, GSD, CPT Assistant. I know there are CPT Assistants about these, codes.
See Dr. Raizman's comment: https://www.aapc.com/discuss/threads/synovectomy.203160/post-556639
Older talk about it here: https://www.aapc.com/discuss/threads/microfracture-documentation.197799/post-542032
Old so verify, but still good info: https://www.aapc.com/blog/33738-337...Edcz63RK_7S83pd-wFI5LB3-Q28SO9_4H2oIDNFKqjG43
Old but still good info: https://www.aapc.com/blog/51405-coding-knee-arthroscopy-with-precision/
NCCI: https://www.cms.gov/files/document/04-chapter4-ncci-medicare-policy-manual-2026-final.pdf
See #6 and:
8. Arthroscopic synovectomy of the knee may be reported with CPT codes 29875 (Limited synovectomy, “separate procedure”) or 29876 (Major synovectomy of two or three compartments.) A synovectomy to “clean up” a joint on which another more extensive procedure is performed is not separately reportable. CPT code 29875 shall not be reported with another arthroscopic knee procedure on the ipsilateral knee. CPT code 29876 may be reported for a medically reasonable and necessary synovectomy with another arthroscopic knee procedure on the ipsilateral knee if the synovectomy is performed in 2 compartments on which another arthroscopic procedure is not performed. For example, CPT code 29876 shall not be reported for a major synovectomy with CPT code 29880 (Knee arthroscopy, medial AND lateral meniscectomy) on the ipsilateral knee, since knee arthroscopic procedures other than synovectomy are performed in 2 of the 3 knee compartments.

Also check the health plan being billed. Example Aetna: https://www.aetna.com/cpb/medical/data/600_699/0673.html
Note: Minor synovectomy (CPT code 29875) is considered integral to all other arthroscopic procedures of the knee. Major synovectomy (CPT code 29876) is only considered medically necessary when a disease of the synovium (e.g., pigmented villonodular synovitis, synovial osteochondromatosis) is identified pre-operatively.