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Thread: Knee Arthroscopy

  1. #1
    Join Date
    Apr 2007
    Sioux Falls, SD

    Red face Knee Arthroscopy

    AAPC: Back to School
    Anyone know of a good ortho coding class?? I need to get in to one asap!
    Here is a knee scope that looks like several other things were done also.
    29880, 29879, 29875, 29873. Can these all be billed?

    PREOPERATIVE DIAGNOSIS: Right knee internal derangement, possible meniscal tear with a lateral tilt and lateral subluxation of the patella.

    POSTOPERATIVE DIGNOSIS: Medial meniscus tear, lateral meniscus tear, patellar subluxation, medial plica and flap tear of the articular cartilage of the medial femoral condyle.

    PROCEDURE PERFORMED: Diagnostic arthroscopy of the right knee with partial medial meniscectomy, partial lateral meniscectomy, arthroscopic lateral release, medial plica excision and abrasion arthroplasty of the medial femoral condyle.



    DESCRIPTION OF THE OPERATION: The patient was prepped and draped in the routine sterile fashion after adequate general anesthesia was obtained. A superior medial portal inflow cannula and lateral portal was scoped. The scope was introduced into the suprapatellar pouch. The patella appeared unremarkable, but it appeared to be tracking laterally. We came down the medial gutter and there was an active synovitis with acute plica. We were able to get by this and under direct visualization an 18 gauge spinal needed and a #11 blade were introduced into the joint and then the inferomedial portal probes were introduced. We had a flap tear of the articular cartilage based medially and coming out of the notch and the entire area of the femoral condyle. The articular cartilage is pulled off. We also had a small tear of the posterior horn of the medial meniscus. We put a shaver and a punch in and trimmed down the medial meniscus. Then we put the shaver in and trimmed down the articular cartilage at the flap tear of the articular cartilage. We went all the way down to the subchondral bone. We eventually came back with a shaver and debrided this all the way down to the subchondral bone. We took out some of the subchondral bone doing an abrasion arthroplasty until we got good bleeding bone. We then proceeded with a notch. The anterior cruciate ligament was inspected. We went over the lateral joint and there was a flap tear that was torn posteriorly and it was flipping out into the joint. We were able to put a shaver and a punch in and trim this down to a nice stable edge eventually. On the lateral meniscus, we probed the rest of the lateral meniscus and this appeared to be stable. We went back up the suprapatellar pouch, inspected the lateral gutter, and then put the scope in from the inferior medial portal and under direct visualization an 18 gauge spine needle and a #11 blade were introduced into the joint and then the inferomedial portal. We put an arthroscopic Mitek VAPR wand in and did an arthroscopic lateral release. Once this was completed we then put the shaver back in into the inferior medial portal and the scope from the lateral portal and removed the entire medial plica, and at that point in time we put the braider in and finished up the abrasion arthroplasty. Once all of this was completed, we made sure there was good bleeding from the abrasion arthroplasty site. We irrigated it out thoroughly. The cannula was removed.
    The knee was injected with 0.5% Marcaine. The portal was closed with an interrupted nylon suture. The patient was put in a bulky dressing and transported to the Recovery Room in stable postoperative condition.
    Donna Struve CPC
    NW Iowa Bone Joint Sports Surgeons

  2. #2
    Join Date
    Apr 2007
    Greater Pittsburgh


    When doing the knee you need to look at the 3 different compartments of the knee

    1. Medial
    2. Lateral
    3. Patella/femoral (Anterior)

    than check your CCI edits. According to your note I would bill 29880 (medial and latera) the 29875 medial plica is included in this because they were in the medial compartment and it is incidental to the meniscectomy and in the CCI edits as such(included).

    In checking the CCI edits the lateral release is not included so you can bill 29873-51 modifier because it is in the same compartment as 29880; BUT if only a medial meniscectomy is done with a lateral release it would go......
    29881(medial) and 29873-59(lateral)-----note different compartments, different modifiers!

    You can also bill the 29879-51 also not in the CCI edits.
    jdemar, CPC, CMA

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