To share arthroscopy coding guidelines, we referred National Correct Coding Initiative (NCCI) policy manual. CMS developed the NCCI manual to promote national correct coding of Medicare Part B claims. The Medicare NCCI promotes correct coding methodologies and controls improper coding leading to improper payment. Before going in detail of arthroscopy coding guidelines, let’s define arthroscopy. Arthroscopy is a surgical procedure that allows the direct visualization of the interior joint space. In addition to providing visualization, arthroscopy enables the process of joint cleansing through the use of lavage or irrigation. Lavage alone may involve either large or small-volume saline irrigation of the knee by arthroscopy. Arthroscopy also permits the removal of any loose bodies from the interior joint space, a procedure termed debridement.
Arthroscopy Coding Guidelines
- Surgical arthroscopy includes diagnostic arthroscopy which is not separately reportable. If a diagnostic arthroscopy leads to a surgical arthroscopy at the same patient encounter, only the surgical arthroscopy may be reported.
- If arthroscopy is performed as a ‘scout’ procedure to assess the surgical field or extent of disease, it is not separately reportable. If the findings of a diagnostic arthroscopy lead to the decision to perform an open procedure, the diagnostic arthroscopy may be separately reportable. While billing Medicare, modifier -58 may be reported to indicate that the diagnostic arthroscopy and non-arthroscopic therapeutic procedures were staged or planned procedures. The medical record must indicate the medical necessity for the diagnostic arthroscopy.
- If an arthroscopic procedure is converted to an open procedure, only the open procedure may be reported. Neither a surgical arthroscopy nor a diagnostic arthroscopy code shall be reported with the open procedure code when a surgical arthroscopic procedure is converted to an open procedure.
- With the exception of the knee and shoulder, arthroscopic debridement shall not be reported separately with a surgical arthroscopy procedure when performed on the same joint at the same patient encounter.
- CPT codes 29874 (Arthroscopy, knee, surgical; for removal of the loose body or foreign body (e.g., osteochondritis dissecans fragmentation, chondral fragmentation) and 29877 (Arthroscopy, knee, surgical; for debridement/shaving of articular cartilage (chondroplasty)) shall not be reported with other knee arthroscopy codes (29866-29889).
- With 2 exceptions, HCPCS code G0289 (Arthroscopy, knee, surgical; for removal of loose body, foreign body, debridement/shaving of articular cartilage at the time of other surgical knee arthroscopy in a different compartment of the same knee) may be reported with other knee arthroscopy codes.
- Since CPT codes 29880 (Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty) same or separate compartment(s), when performed) and 29881 (Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty) same or separate compartment(s), when performed) include debridement/shaving of articular cartilage of any compartment, HCPCS code G0289 may be reported with CPT codes 29880 or 29881 only if reported for removal of a loose body or foreign body from a different compartment of the same knee.
- HCPCS code G0289 shall not be reported for removal of a loose body or foreign body or debridement/shaving of articular cartilage from the same compartment as another knee arthroscopic procedure.
- Shoulder arthroscopy procedures include limited debridement (e.g., CPT code 29822) even if the limited debridement is performed in a different area of the same shoulder than the other procedure. With 3 exceptions, shoulder arthroscopy procedures include extensive debridement (e.g., CPT code 29823) even if the extensive debridement is performed in a different area of the same shoulder than the other procedure. CPT codes 29824 (Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure)), 29827 (Arthroscopy, shoulder, surgical; rotator cuff repair), and 29828 (Arthroscopy, shoulder, surgical; biceps tenodesis) may be reported separately with CPT code 29823 if the extensive debridement is performed in a different area of the same shoulder.
- Arthroscopic synovectomy of the knee may be reported with CPT codes 29875 (Limited synovectomy, ‘separate procedure’) or 29876 (Major synovectomy of two or three compartments). A synovectomy to ‘clean up’ a joint on which another more extensive procedure is performed is not separately reportable.
- CPT code 29875 shall not be reported with another arthroscopic knee procedure on the ipsilateral knee. CPT code 29876 may be reported for a medically reasonable and necessary synovectomy with another arthroscopic knee procedure on the ipsilateral knee if the synovectomy is performed in 2 compartments on which another arthroscopic procedure is not performed. For example, CPT code 29876 shall not be reported for a major synovectomy with CPT code 29880 (Knee arthroscopy, medial and lateral meniscectomy) on the ipsilateral knee, since knee arthroscopic procedures other than synovectomy are performed in 2 of the 3 knee compartments.
Medical Billers and Coders (MBC) is a leading medical billing company providing complete medical billing and coding services. Arthroscopy coding guidelines are shared only for reference purposes, you can refer the following link for a detailed understanding. If you need assistance in orthopedic coding or billing for your practice, call us at: 888-357-3226 or email us at: firstname.lastname@example.org.
Reference: Medicare NCCI Coding Policy Manual