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Knee surgery-excision medial plica

  1. Post Knee surgery-excision medial plica
    Medical Coding Books
    Ok, surgery was done arthroscopy synovectomy of medial, lateral, and patella compartment. Chondroplasty was also perfomed in the patella and exscion of medial plica was done due to rubbing of the medial femoral condyle raw that caused redness at the medial femoral condyle.

    Question is the medial plica excision included with the synovectomy which in this case will only be able to code for 29876? Please let me know if i am on the right track.

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    Quote Originally Posted by amartinez1 View Post
    Ok, surgery was done arthroscopy synovectomy of medial, lateral, and patella compartment. Chondroplasty was also perfomed in the patella and exscion of medial plica was done due to rubbing of the medial femoral condyle raw that caused redness at the medial femoral condyle.

    Question is the medial plica excision included with the synovectomy which in this case will only be able to code for 29876? Please let me know if i am on the right track.
    29876 for medial + lateral. You could bill the 29877 Chondroplasty for the patella with a 59 mod. But expect a denial and be ready to appeal.

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    A little confused about the plica excision as to what compartment it is in. Is it the medial compartment or patella? Also what is the plica excision bundled in to? I have read its bundled in with the chondroplasty but also into the synovectomy and that the chondroplasty is included in with synovectomy. If i appeal when it denies what would the justification be? Please help me help to understand and thanks.

  4. #4
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    Quote Originally Posted by amartinez1 View Post
    A little confused about the plica excision as to what compartment it is in. Is it the medial compartment or patella? Also what is the plica excision bundled in to? I have read its bundled in with the chondroplasty but also into the synovectomy and that the chondroplasty is included in with synovectomy. If i appeal when it denies what would the justification be? Please help me help to understand and thanks.
    medial plica is in the medial compartment as the synovectomy (29876) will cover both the medial and lateral compartments. The chondroplasty (29877), which was done in the patellofemoral compartment, would be reimburseable as being performed in a separate compartment from the 29876. Hope this helps..

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    One more question if you will answer. So i could still bill the chondroplasty for the patella even if synovectomy was also done in that same compartment thought synovectomy included the chondroplasty?

  6. #6
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    Quote Originally Posted by amartinez1 View Post
    One more question if you will answer. So i could still bill the chondroplasty for the patella even if synovectomy was also done in that same compartment thought synovectomy included the chondroplasty?
    No you can't capture a chondroplasty + synovectomy in the same compartment. You can capture it (although it will probably need an appeal) when performed in separate knee compartments. If they denied the 29877 with a 29876 your appeal would be based on the 29876 being peformed in the medial + lateral compartments and the 29877 being performed in the patellofemoral compartment. CPT and AAOS allow this type of coding. Hope this helps. I couls send you some articles that could back up an appeal..

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    THOSE ARTICLES IF YOU COULD SEND THEM WOULD BE GREAT. JUST IN CASE I NEED THEM AND IM SURE I WILL. IF YOU WANT TO POST IT ON HERE OR YOU CAN SEND IT TO angelica.martinez81@yahoo.com. Just wasn't sure about the chondroplasty and synovectomy. That gets confusing to me since synovectomy was done in patella and so was chondroplasty. Thanks again hope to here from you soon.

  8. #8
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    Hello....can someone email me those articles too? They would be most helpful with what I'm doing. THanks! My email is starcoder71@gmail.com

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