CPT 29881 is a musculoskeletal surgery code. According to general coding guidelines, it describes as the removal of one knee cartilage with the help of an endoscope. The coder may submit this code when the physician performs only a single arthroscopic procedure for each compartment in the knee.
Description Of CPT Code 29881
CPT code 29881 can be reported for knee joint with an arthroscope. The knee joint is examined and the joint is repaired by removing the meniscus from either the lateral or medical compartments of the knee joint.
The following are the main components of compartments:
Lateral: lateral meniscus, lateral tibial plateau, and lateral femoral condyle
Medial: medial meniscus, medial tibial plateau, and medial femoral condyle
The joint (patellofemoral): the trochlear notch of the femur and synovial plicae are all related structures. The ACL supports the ligament of the knee. The ACL holds the femur in place on the tibia and prevents it from sliding rearward. In addition, the ACL, together with the posterior cruciate ligament, provides rotational stability to the knee.
Billing Guidelines And Reimbursement Policy
CPT 29881 falls in the category of arthroscopic surgical procedure. CPT code 29881 is reportable when the physician accomplishes only a single arthroscopic procedure for each compartment in the knee. This code also includes a meniscectomy for the lateral or medial compartment.
Surgical arthroscopy always includes a diagnostic arthroscopy of the same joint.
The CMS categorizes procedures of Surgical Knee Arthroscopy into CPT codes 29866 – 29868, 29871 – 29889.
Knee arthroscopy is a common and effective method of identifying knee problems such as meniscus tears and cartilage degradation.
However, to report services correctly and ensure maximum reimbursement, orthopedic surgeons and their medical coding service providers must understand the different CPT codes involved. And Medicare’s National Correct Coding Initiative (NCCI) procedure-to-procedure edits private payer guidelines.
A fiber optic endoscope is helpful to see the joint space of the knee during knee arthroscopy. Instead of performing an available treatment, the surgeon can perform arthroscopic surgery with equipment inserted through small incisions.
For evaluating meniscectomy and meniscal repair, the three principal components of the knee are critical factors.
A meniscectomy (CPT 29880 and CPT 29881) is a surgical procedure that removes all or part of a damaged meniscus. CPT, AAOS, and Medicare accept all these knee regions.
The following are the relevant CPT codes:
CPT 29880: Arthroscopy, knee, surgical; with the meniscectomy including debridement or Chondroplasty, same or separate compartment(s).
CPT 29881: with meniscectomy including debridement/shaving of articular cartilage same/separate compartment(s).
When a meniscal tear is repairable, use the codes:
CPT 29882: For meniscus fix (lateral or medial).
CPT 29883: For meniscus repair (lateral and medial).
Meniscectomy and meniscal repairs are the most common procedures, and they can be done alone or in combination with other methods.
If a physician performs a second procedure in a different compartment, the coder can report it. Chondroplasty is not inclusive of the meniscal repair codes.
CPT 29877 defines as a surgical arthroscopy of the knee; articular cartilage debridement/shaving (Chondroplasty). The CPT and GSD standards for reporting CPT 29877 are not the same as those used by Medicare.
According to the CPT definition, the coder must document arthroscopic Chondroplasty in the medial, lateral, or patellofemoral compartment(s). In addition, he must report it once per surgical session when performed in a separate container, with other arthroscopic procedures omitting meniscectomy procedures.
According to the GSD standards, Chondroplasty is independently reportable with the other procedures if performed in a distinct compartment without further surgical treatment.
Therefore, it is not included in the principal code by definition. The definition also states that Chondroplasty is separately reportable from other procedures when performed in a separate compartment where the physician performs no other surgical procedure.
Therefore, it is not included in the primary code by definition. According to CPT guidelines, modifier 59 may indicate that Chondroplasty was the only procedure performed in a distinct compartment.
Medicare recommends using HCPCS Level II code G0289 Arthroscopy, knee, surgical, to remove a loose body or a foreign body. Chondroplasty is not billable to CMS or other payer companies when combined with meniscal repairs.
Although CMS designed G0289 to report Medicare claims, several non-Medicare payers also have adopted it. Chondroplasty is present in their definitions.
The coder can use neither CPT 29877 nor CPT G0289 to report Chondroplasty with meniscectomy CPT 29880 or CPT 29881.
When performed in a distinct compartment, Chondroplasty (29877 or G0289) may be reported separately with meniscal repair codes CPT 29882 and CPT 29883 as long as no other reportable service is there.
For Medicare claims, one may not use modifier 59. CPT G0289 is assumed to be the arthroscopic removal of a loose body or foreign body in a separate compartment by Medicare.
When reporting CPT 29877 to private payers, modifier 59 might indicate that it fulfills the distinct compartment rule.
CPT 29874 defines knee arthroscopy as reducing the loose body or foreign body. One may document CPT 29874 with a primary service such as meniscectomy or meniscal repair for non-Medicare patients; however, it may be within the same compartment.
To indicate that it fulfills the size of distinct incision criteria, use modifier 59. CPT 29875 is an arthroscopy of the knee; synovectomy. It defines limited synovectomy as a separate procedure.
Therefore, the coder must report CPT 29875 when it is the only arthroscopic procedure performed on that knee. Therefore, compartments are not significant for writing this CPT code.
CPT 29876 describes as surgical arthroscopy of the knee; significant synovectomy for two or more containers. Documentation must show pathologic synovial disease when reporting CPT 29876 and another arthroscopic knee operation.
For this service, Medicare and other insurances have distinct rules. CPT 29884 is a surgical arthroscopy of the knee with or without adhesion lysis.
When the physician conducts a scope operation in conjunction with available treatment, Medicare and several other third-party payers do not approve it. Individual payers may have different coding guidelines.
Medicare does not accept CPT 29981 with CPT 29870 — CPT 29887. A separate HCPCS code is used for Chondroplasty and loose foreign body removal but performed on a single-person compartment.
If the physician executes the procedure on the right knee, use the RT modifier. If he completes the process on the left knee, use the LT modifier. When the physician accomplishes Chondroplasty on the right side and meniscectomy on the left side, one can use modifier 59.
The coder can use XP, XS, XU, and XE modifiers with CPT 29811. CPT code 29881 has a 90 – day global surgery post-operative period.
According to CPT guidelines, if the physician cannot complete the procedure using the arthroscope and must do an open process, list the available procedure first. And code the arthroscopy as diagnostic, and add modifier 51.
In addition, as per guidelines, Strapping and Cast Application is only documented when it is an initial service performed without a restorative procedure or treatment.
Examples For CPT Code 29881
Underneath four billing examples for CPT code 29881.
Arthroscopic left lateral meniscectomy, and arthroscopic Chondroplasty are performed and documented by the surgeon. The code 29881 is reportable.
Even though the physician conducts treatment in two independent compartments, the Chondroplasty is all-inclusive and not separately reportable.
In addition, Chondroplasty is not individually reportable because the information and medical necessity supported meniscectomy as the primary treatment.
The surgeon recorded CPT 29882 and CPT 29881-59 for a right medial Meniscectomy, lateral meniscal repair, and tri-compartmental Chondroplasty. CPT code 29881 has a modifier 59 to indicate a separate procedure in a different anatomic site (lateral repair vs. medial meniscectomy).
Even though CPT code 29882 does not bundle the Chondroplasty. But CPT 29881 prevents Chondroplasty from being reported in the patellofemoral compartment.
The physician initially inserts the arthroscope through the anterolateral portal. And then through the medial suprapatellar portal. The lateral compartment appeared to be in good condition.
There were some minor degenerative alterations in the medial column. He detected a full-thickness region of osteochondral degeneration with a cartilage flap in the medial compartment.
He may use a bleeding bony bed with beveled cartilage edges to remove it. The ligament itself appeared to be in good condition. He detected Grade I chondromalacia alterations in the retro-patellar region.
He examined the medial joint and found a tear at the intersection of the middle and posterior parts of the meniscus and a flap tear more anterior.
The meniscus was debrided back to a smooth, stable rim using a combination of small baskets and punches. He used the curved automated meniscal incisor to remove another synovitis.
The physician performed a surgical arthroscopy of the knee. We’ll look for the CPT arthroscopy/surgical/knee 29866 – 29868 or 29871 – 29889. The coder documented CPT 29881, a medial meniscectomy, and debridement.
The synovectomy, code 29875, is a different procedure combined with CPT 29881 and not recorded separately in this case.
The patient’s medial meniscus tear apart. The provider inserted an arthroscope through the anterolateral portal for the diagnostic procedure. Only the patellar side of the patellofemoral joint had grade 2 chondromalacia.
And he debrided it with a 4.0-mm shaver. A complicated posterior horn rupture of the medial meniscus was present in the medial compartment. He examined it to determine its boundaries. To achieve a secure rim, he performed a meniscectomy.
Because the tear was in the medial meniscus, the code is 29881. The provider performed a meniscectomy and shaver debridement (or Chondroplasty).
The coder does not report CPT 29877 because it is part of CPT 29881. Because the provider completed a meniscectomy in both the medial and lateral compartments, CPT 29880 is not acceptable.
The surgery began as a diagnostic test, but the doctor opted to undertake surgical treatments on the knee, which changed the outcome.