Wiki Knee Compartments

[ercoder65]

I am sure this question has been raised many times; unfortunately I can not find the answer in the archives. In regards to modifier 59, if a procedure on the right knee was performed in the lateral compartment, could you code a procedure done in the other compartments using modifier 59? The language of usage of modofer 59 can be confusing; they use the phrase 'different site or organ system'. Isn't the knee...........just the knee? Or, do the different compartments skirt around the issue of 'different site'? I appreciate any advice. Thanks in advance.

 

[poonamsawant]

Hi,

Certain knee procedure codes are compartment based such as 29879, 29877 etc, thus if done on more than 1 compartment, modifier 59 can be assigned.

Thanks
Dr. Poonam

 

[lavanyamohan]

Hi,
A lateral meniscal repair can follow a medial meniscal and or collateral ligament/tendons procedure on the same knee as required due to arthrosis, joint fluid collection, tendinosis, etc.
Can try 59 modifier.
But for injury due to fall can be considered bundled. Everything depends on Dx suggesting appropriate medical need.

LMohan

 

[coderguy1939]

Take a look at CPT Assistant August 2001 Arthroscopic Knee Procedures. You may also want to visit the AAOS website and download some of their archived material on the subject.

 

[mbort]

I agree with coderguy. There is information that will be of great use on the AAOS website.

There are three separate compartments to the knee:
Medial
lateral
patellorfemoral

Its EXTREMELY important to know what compartment procedures are being performed....the rules vary by payor for some procedures as well.

 

[aprilroc]

I agree with Mary also, when billing 29877 or 29874 in a totally different compartment than the primary scope then bill to medicare as G0289 with no modiier, some other payors want this code billed also.

 

[kevaro]

If you have a dx of 726.65 Prepatellar bursitis with a Medial Meniscus Tear 836.0 that would qualify you to use two different procedures codes for the different part of the same knee using the Modifier 59. You just have to make sure you match the correct dx with the correct procedure. Hope this helps.