knee scope question

monica03

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I am having trouble with the coding of this knee scope. The doctor turned in 29881 and 29855x2. I don't agree with 29855x2 because one of the arthroscopic assisted fixes is for the femur.

PROCEDURE
1. Arthroscopic assisted internal fixation of the left medial plateau with AccuFill Bone Substitute Material.
2. Arthroscopic assisted internal fixation of the left medial femoral condyle with AccuFill Bone Substitute Material.
3. Partial medial meniscectomy.

OPERATIVE FINDINGS:
Preoperatively, he had full extension and flexion to 120 degrees and no instability. There was a moderate clear effusion. The patella had minor chondromalacia changes. The trochlear groove was normal in appearance. The medial and lateral femoral condyle and tibial plateau and meniscus were normal. The ACL and PCL were intact. The medial femoral condyle had diffuse grade 3 chondromalacia and a small area of grade 4 chondromalacia in the weightbearing portion. The medial tibial plateau had extensive 2 and 3 chondromalacia. There was degenerative tear of the posterior horn body of the medial meniscus. The anterior horn was intact.

DESCRIPTION OF PROCEDURE
The patient was taken to the operating room where he was administered 2 grams of Ancef. He was also given a general anesthetic. A well-padded tourniquet was placed on the left upper thigh, and the left leg was prepped and draped in a sterile manner. Timeout was performed. Using fluoroscopy, 2 cannulas were placed appropriately in the medial femoral condyle and tibial plateau. The medial femoral condyle was somewhat in the medial sided posterior portion. The medial tibial plateau was in the midportion. After appropriate trocar placement, 4 cc of AccuFill Bone Substitute Material was placed in the medial tibial plateau and 6 cc of AccuFill Bone Substitute Material was placed in the medial femoral condyle. After placing the bone substitute material, the cannulas were left in place for 12 minutes and then both were removed. The small stab wounds were closed with interrupted 3-0 Ethilon suture.

The leg was then exsanguinated and the tourniquet inflated to 300 mmHg. An inferior medial and lateral portals were established with the above-noted findings. A small flap tear occurred in the medial femoral condyle and was debrided. The posterior horn and medial meniscus tear was debrided with baskets and forceps with the appropriate contouring anteriorly and posteriorly. All loose pieces of cartilage were removed. The portals were closed with interrupted 3-0 Ethilon suture. Marcaine 0.5% with epinephrine was injected intra-articularly. Xeroform and a sterile dressing were applied. The tourniquet was released.​

Any help is greatly appreciated.
 

sxcoder1

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I have a medial femoral condyle subchondroplasty to code also. I think 29855 has been used in the past, but I didn't think it was appropriate either because it was femur. I also have an open one to code. I am thinking of unlisted?
 

monica03

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Greenwood, SC
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I have a medial femoral condyle subchondroplasty to code also. I think 29855 has been used in the past, but I didn't think it was appropriate either because it was femur. I also have an open one to code. I am thinking of unlisted?
That is kind of what I am leaning towards at this point too and then refer back to 29855?
 

terribo

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Greenville, NC
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I have a medial femoral condyle subchondroplasty to code also. I think 29855 has been used in the past, but I didn't think it was appropriate either because it was femur. I also have an open one to code. I am thinking of unlisted?

Monica03, did you get paid for the medial femoral condyle subchondroplasty? CPT 29855 is approved to be used for the DX of a fracture of the tibial plateau; however, if the procedure is performed on the femoral condyle, the code has to go unlisted as 27509. From what I understand, the recommendation is to compare it to 29855. We are located in Greenville, NC, and we are not receiving payment. If you recieved payment, what code did you use? What information did you put in block 19 of the claim form to describe the procedure to the patient if submitted unlisted 27509?

Thank you for your help.
 
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