Knee Arthroscopy- CPT code 29881, 29880 and 29877

Coding Knee arthroscopic procedures looks tricky but are not that confusing. There are few codes have been bundled with major knee arthroscopic procedures. For example, now the CPT codes 29881 and 29880 will include the chondroplasty procedure if performed on same knee. Chondroplasty performed in any of the compartment like medial, lateral or patella-femoral, it will be included with CPT code 29881 and 29880.

In arthroscopic knee surgery, the above three compartment play an important role in selecting a correct procedure code. Like CPT code 29881 is coded for of surgical meniscectomy for medial or lateral compartment. If meniscectomy is performed on both compartments, CPT code 29880 is assigned. In both procedures, chondroplasty will be included if performed on same knee irrespective of the compartment. Below are the CPT code descriptions for knee arthroscopic procedures.

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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

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

29877 – Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)

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Procedure performed for CPT code 29881, 29880 and 29877

For CPT code 29880 & 29881, the physician makes 1 cm long portal incisions on either side of the patellar tendon for arthroscopic access into the knee joint. Once the meniscal tear is identified, additional portal incisions may be made to provide easier access to the area. There may be a tear on both the medial and lateral meniscus (CPT code 29880) or only the medial or the lateral meniscus (CPT code 29881).

The procedure is the same for medial or lateral meniscal tears. Angled scissors, a motorized cutter, or punch forceps remove torn fragments. The remaining intact meniscus is trimmed and contoured. Lesions in the articular cartilage in the same or a different compartment may be identified by the arthroscope and the use of a probe. Additional portal incisions may be made to provide better access to the cartilage lesions. Debridement of the unstable hyaline cartilage or partially fragmented cartilage is accomplished with a motorized suction cutter. This smooths the roughened or damaged cartilage. Any loose bodies are removed. After debridement, the joint is flushed. A temporary drain may be applied and the incisions closed with sutures and Steri-strips.

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When to use CPT code 29881,29880 and 29877

CPT code 29877 is included with CPT code 29881 and 29880 when performed on same knee. However, if the procedures are performed on different knee, for example Chondroplasty is performed on left knee and meniscectomy is performed on right knee in such cases we can code them together using 59 modifier. When Chondroplasty is coded with meniscectomy CPT code 29881 and 29880, the procedure code 29877 will be appended with 59 or the new XP, XS, XU, XE modifier. Never use the chondroplasty CPT code 29877 along with meniscectomy when performed on same knee. The procedures will not get paid in such scenarios and the claim will be denied.

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Do and Don’t with CPT code 29881 and 29880

Do not use CPT code 29881 and 29880 together unless the procedures are performed on different knee. If performed on different knee, use them together will appropriate modifier.
Do not use CPT code 29877 with CPT code 29881 and 29880 if performed on same knee. Chondroplasty is included with CPT 29881 and 29880 and should not coded separately.
Do code Chondroplasty when performed on different knee with CPT code 29881 and 29880. CPT code 29877 should be appended with modifier 59 when coded with CPT 29881 and 29880.

Below supply codes are used with above procedures.

SA048 pack, minimum multi-specialty visit
SA054 pack, post-op incision care (suture)

When reporting arthroscopic knee procedures for Medicare patients, the major procedure being performed should be coded using the standard arthroscopy codes (29870–29887). If chondroplasty and/or loose/foreign body removal is done in a different compartment of the same knee, add on code G0289 may be assigned. Do check with your carriers or local third-party payers for their guidelines regarding these services.

Read also: when to use CPT code 29881, 29880 and G0289 Together

Other related CPT codes for Knee arthroscopy

• 29850 – Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation; without internal or external fixation (includes arthroscopy)
• 29851 – ; with internal or external fixation (includes arthroscopy)
• 29855 – Arthroscopically aided treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed (includes arthroscopy)
• 29856 – ; bicondylar, includes internal fixation, when performed (includes arthroscopy)
• 29866 – Arthroscopy, knee, surgical; osteochondral autograft(s) (e.g., mosaicplasty) (includes harvesting of the autograft[s])
• 29867 – ; osteochondral allograft (e.g., mosaicplasty)
• 29868 – ; meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateral
• 29870 – Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)

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Sample Coded report for Procedure code 29881

PREOPERATIVE DIAGNOSIS:
A 68-year-old male patient presents for outpatient surgery. He complains of increasing pain to the left knee over the past 10 months, and was found to have a torn lateral meniscus of the left knee.
POSTOPERATIVE DIAGNOSIS:
Torn lateral meniscus of the left knee and an articular flap of the medial femoral condyle, also of the left knee.

PROCEDURES:
1. Arthroscopy, left knee, with meniscectomy
2. Arthroscopy, left knee, with debridement of the articular flap medial femoral condyle

DESCRIPTION OF PROCEDURE:
The patient was placed supine on the operating room table. After general anesthesia was administered, the left lower extremity was prepped and draped in the usual sterile manner for arthroscopic surgery. The knee was arthroscoped through the standard medial and lateral portals and the entire knee joint was evaluated. He was found to have a large, loose articular surface flap of the medial femoral condyle, degenerative extensive tear of the lateral meniscus, and mild degenerative changes of the lateral compartment.

Using a combination of manual and power instrumentation, a lateral meniscectomy was performed. This was followed by removal of the unstable flap of cartilage of the medial femoral condyle. Next, an arthroscopic shaver and Stryker electrocautery at a very low setting were used to perform a chondroplasty and debridement of the articular cartilage in the involved areas of the medial femoral condyle. This part of the surgery took 25 minutes.

After copious irrigation, all fragmented tissue was removed. The arthroscope was then removed. The skin portals were closed with a single 4-0 nylon stitch. The knee was injected with 20 cc of Marcaine and 1 cc of Kenalog 40. The patient was taken to the recovery room in stable condition. There were no complications. All sponge and instrument counts were correct.

CPT Codes
29881 – Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving)

G0289 Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee

Rationale: The G code G0289 should be used only for Medicare patients when the removal of foreign body or chondroplasty is performed in different compartment of knee.