Surgery Center Coding Guidance: Lower Extremity Arthroscopy Procedures

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Editor's Note: This article by Paul Cadorette, director of education for mdStrategies, originally appeared in The Coding Advocate, mdStrategies free monthly newsletter. Sign-up to receive this newsletter by clicking here.

Hip Arthroscopy

• 29863 – Synovectomy, this code is used for both a partial or complete synovectomy.
• 29914 – Femoroplasty is used to treat a cam lesion (bump on the femoral neck).
• 29915 – Acetabuloplasty is used to treat a pincer lesion (deep socket of the acetabulum or overgrowth of acetabular bone).
• Debridement (29862) and synovectomy (29863) codes are not reported in addition to the femoroplasty, acetabuloplasty or labral repair codes 29914-29916
• A labral repair (29916) is not reported secondary to an acetabuloplasty.  For example, the patient presents with a pincer lesion (overgrowth of acetabular bone) and the physician performs a "rim trimming." The labrum is released so that the acetabulum can be trimmed back, then the labrum is reattached to the acetabulum.  In this case the labral repair is secondary to the acetabuloplasty so code 29916 is not additionally reported.

Knee Arthroscopy

• A chondroplasty (debridement of articular cartilage) is never reported with meniscectomy codes 29880/29881 even if the chondroplasty is performed in a separate compartment because the chondroplasty procedure is included in the CPT code definition for codes 29880/29881.
• When a medial compartment meniscectomy and synovectomy are performed along with a lateral compartment meniscectomy and synovectomy the coder may report 29880 and 29876 per the AMA.  Keep in mind however that for Medicare patients 29876 bundles into 29880.
• 29873 – When a "lateral" retinacular release is performed the procedure is performed in the "patellofemoral" compartment and not the lateral compartment.
• When the physician performs a diagnostic arthroscopy, removes the scope and manipulates the knee to break up adhesions the procedure is still reported with code 29884 because the individual codes of 29870 and 27570 are considered included in the global service package for 29884.

Ankle/Subtalar Arthroscopy

• There isn't a code for diagnostic arthroscopy procedures of either the ankle or subtalar joints so diagnostic arthroscopy procedures performed on these joints would be reported with unlisted code 29999.
• Arthroscopic medial and lateral synovectomy of the ankle joint is reported with code 29895 – synovectomy, partial.
• An OATS procedure of the talus is reported with CPT code 29892 - Arthroscopically aided repair of large OCD lesion, talar dome fracture, or tibial plafond fracture, with or w/o internal fixation, even though reference to the OATS is not specifically made in the code descriptor for 29892.

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