I'm seeking guidance on the use of CPT code 29876. I have surgeons who continue to use CPT 29876 for procedures when there is no documentation of pathological synovial disease being present in the operative report. Is there another code that would be better? Including the body of the operative report for help! We keep getting medical necessity denials because of this, and the surgeon's office is only getting approval for CPT 29875.
Excerpt from operative report:
"History: The patient has had pain and mechanical symptoms in the right knee after knee replacement. This seems to be mostly in the patellofemoral area laterally and medially. His workup to date had been negative. He had an injection around his iliotibial band which was not helpful. Given his mechanical symptoms we are hopeful that there would be an area of scar tissue or synovitis in the anteromedial or anterolateral gutter that was impinging under the patella. Having failed conservative management we elected to proceed with arthroscopic evaluation and debridement and synovectomy...
Findings: Examination under anesthesia revealed full range of motion with a stable ligament exam. The knee was very stable to varus and valgus both in flexion and extension and mid flexion. Soft tissue anteromedially and anterolaterally which was thickened and was able to fold over the patella potentially able to imping between the patella and anterior femur. This was debrided medially and laterally.
Procedure: ...After surgical timeout, a standard inferolateral portal was established and the cannula was placed in the knee. The fluid was sent for culture x3. The scope was placed in the knee. After localization with spinal needed an inferomedial portal was established. The knee was examined and findings are described above. Using shave and RF probe from the inferomedial inferolateral and a superomedial portal the soft tissue and the medial and lateral gutters were debrided. Some soft tissue in the suprapatellar pouch was debrided. There was nothing left that appeared to be able to impinge within the knee. The knee was then suctioned dry. The knee and subcutaneous tissues were instilled with local anesthetic....
Excerpt from operative report:
"History: The patient has had pain and mechanical symptoms in the right knee after knee replacement. This seems to be mostly in the patellofemoral area laterally and medially. His workup to date had been negative. He had an injection around his iliotibial band which was not helpful. Given his mechanical symptoms we are hopeful that there would be an area of scar tissue or synovitis in the anteromedial or anterolateral gutter that was impinging under the patella. Having failed conservative management we elected to proceed with arthroscopic evaluation and debridement and synovectomy...
Findings: Examination under anesthesia revealed full range of motion with a stable ligament exam. The knee was very stable to varus and valgus both in flexion and extension and mid flexion. Soft tissue anteromedially and anterolaterally which was thickened and was able to fold over the patella potentially able to imping between the patella and anterior femur. This was debrided medially and laterally.
Procedure: ...After surgical timeout, a standard inferolateral portal was established and the cannula was placed in the knee. The fluid was sent for culture x3. The scope was placed in the knee. After localization with spinal needed an inferomedial portal was established. The knee was examined and findings are described above. Using shave and RF probe from the inferomedial inferolateral and a superomedial portal the soft tissue and the medial and lateral gutters were debrided. Some soft tissue in the suprapatellar pouch was debrided. There was nothing left that appeared to be able to impinge within the knee. The knee was then suctioned dry. The knee and subcutaneous tissues were instilled with local anesthetic....