Wiki Meniscectomy with tophi removal

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TJAlexander

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Our provider removed what he called 'gouty tophi' from the patellofemoral joint then did a partial meniscectomy of the lateral meniscus. Am I able to bill for the removal of the tophi or is it included as 29877 or 29874?

"The patient is evaluated. Preoperative H&P updated. The left knee was marked. Taken to the operating room and place in a supine position, prepped, draped sterilely. We then made our anterior and lateral portal incisions with an 11 blade, followed by arthroscopic trocar. Within the lateral portal, we placed our camera within the patellofemoral joint. We noticed that there were significant multiple tophi and loose bodies. These were removed. We then used our shaver, performed a tophectomy, and removed multiple areas of tophi in the patellofemoral joint. We then put the knee in low valgus force. We noticed the anterior tear of the lateral meniscus. We then used our shaver and biter to perform a partial meniscectomy."

I'm relatively new to orthopaedics but is a tophectomy actually a thing??

Thanks!
 
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Tophi is a real thing and some codes will include it in the description. What is the patient's diagnosis? I'm not sure the term gouty tophi can be used without an appropriate diagnostic code.
Does either code you mention say anything about removing any loose bodies?
 
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Report this procedures with 29881 . Removal of multiple tophi and loose bodies are not reported separately with 29877 or 29874 as there is NCCI edits against reporting them together.

Hope this helps.
 
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Ok, that's what I thought. I think I was thrown by gouty tophi. That wasn't a term I'd heard before and couldn't find a CPT code that described removing it. Thanks for your help!
 
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The trick is to look up any term you don't recognize in a medical dictionary so you have a point of reference when you read the op note. Otherwise you're just guessing at what went on.
 
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