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Basics of CPT code 29914, 29915, and 29916

CPT code 29914, 29915, and 29916 represent procedures performed specifically for the treatment of femoroacetabular impingement (FAI). In FAI, the femoral head and acetabulum, a ball and socket joint do not fit perfectly. This will cause friction during hip movements, which can cause damage to the hip joint. The damage may be on the smooth white surface of the ball or socket or the labral cartilage, a soft tissue surrounding the socket. A Labral tear is mainly responsible for causing hip pain because the labrum has nerve ending that causes pain sensation in the hip region. The main objective of hip surgery is to correct the shape variation that causes impingement and reduces the pain and improve hip rotation.

CPT Code description of 29860, 29861, 29862 and 29863

29860 Arthroscopy, hip, diagnostic with or without synovial biopsy (separate procedure)
29861 Arthroscopy, hip, surgical; with removal of loose body or foreign body
29862 with debridement/shaving of articular cartilage (chondroplasty), abrasion arthroplasty, and/or resection of labrum
29863 with synovectomy
#29914 with femoroplasty (ie, treatment of cam lesion)
#29915 with acetabuloplasty (ie, treatment of pincer lesion)
#29916 with labral repair

When to use CPT code 29860 and 29861

We have both diagnostic and surgical procedure codes for hip arthroscopy. As we all know the diagnostic procedures are always included in the surgical procedure codes. Here also, CPT code 29861 includes the diagnostic arthroscopy hip exam 29860. This is the reason, code 29860 is designated as a “separate procedure” because, as with all arthroscopic procedures in CPT, a surgical arthroscopy always includes a diagnostic arthroscopy. CPT code 29861 describe a surgical hip arthroscopy with the removal of a loose or foreign body. Loose bodies represent a significant source of painful hip symptoms. An arthroscopy exam uses less invasive techniques to remove the loose bodies than the open surgery procedures.

When to use CPT code 29862 & 29863

Code 29862 and 29863 are added under CPT code 29861, to describe a surgical hip arthroscopy with debridement/shaving (chondroplasty) and synovectomy. CPT code 29863 description does not specify “partial” or “complete,” as there is minimal additional work in the performance of complete versus partial synovectomy of the hip. Therefore, code 29863 should be reported for either a partial or complete arthroscopic synovectomy of the hip. CPT code 29862 is reported when an articular cartilage is debrided/shaved, or an abrasion arthroplasty is performed. A resection of the labrum may also be performed.

Difference between cam and pincer

There are generally two forms of FAI: cam and pincer. The cam form describes the femoral head and neck relationship as aspherical or not perfectly round. In this form of FAI, a bump on the femoral neck comes into contact with the rim of the socket when the hip is bent up. This loss of roundness contributes to abnormal contact between the head and socket. The pincer form of FAI describes the situation in which the socket or acetabulum has too much coverage of the ball or femoral head, often from the formation of a spur that extends out from the edge of the socket. This extra coverage typically exists along the front top rim of the socket (the acetabulum), and causes the labral cartilage to be “pinched” between the rim of the socket and the anterior femoral head-neck junction.
The cam and pincer forms of FAI also may exist together (ie, mixed impingement).

When to use CPT code 29914

When an a X ray of hip shows a cam lesion at the femoral head neck junction, a surgery is recommended to reshape the femoral head and neck junction. The physician performs a arthroscopic femoroplasty for the treatment of a cam lesion. It is also a type of femoroacetabular impingement. CPT code 29914 is reported for treatment for cam lesion through arthroscopy femoroplasty. Targeted sections of femoral head and anterior femoral neck is removed to increase clearance in the joint.

The physician performs an arthroscopic femoroplasty for the treatment of a cam lesion, a type of femoroacetabular impingement caused by a “bump” on the surface of the femoral head that abuts against the acetabulum rim; most common in young athletic males. With the patient under appropriate anesthesia, the hip is subluxed using leg traction to allow adequate visualization through the arthroscope. The physician creates portals through which an arthroscope and surgical instruments are inserted. Irrigation fluid is directed into each compartment of the joint using the arthroscope for visualization. Targeted sections of the femoral head and anterior femoral neck are removed to increase clearance in the joint. Range of motion (ROM) and any residual impingement are evaluated. The instruments are removed. A temporary drain may be placed, and the incisions are closed with Steri-strips and/or sutures.

When to use CPT code 29915

This code is used for treatment of pincer lesion. The hip pain is worse while sitting and arising from a seated position. The X ray of hip usually shows a crossover sign of the acetabulum. The physician performs the acetobuloplasty to remove the portion of the bony acetabular rim and eliminate the abnormal contact between the rim and the femoral neck. A capsuolotomy is performed to facilitate the resection in the peripheral compartment. CPT code 29915 is reported only for pincer lesion performed with acetabuloplasty.

The physician performs an arthroscopic acetabuloplasty for the treatment of a pincer lesion, a type of femoroacetabular impingement caused by an abnormal overhand of the acetabular rim; most common in middle-aged women. With the patient under appropriate anesthesia, the hip is subluxed using leg traction to allow adequate visualization through the arthroscope. The physician creates portals through which an arthroscope and surgical instruments are inserted. Irrigation fluid is directed into each compartment of the joint using the arthroscope for visualization. If necessary, due to the size of the pincer lesion, the labrum may be detached using a curved blade. Using a motorized burr, the acetabuloplasty is performed, removing a portion of the acetabular rim. Suture repair is performed if detachment of the labrum is necessary. The instruments are removed. A temporary drain may be placed, and the incisions are closed with Steri-strips and/or sutures.

When to use CPT code 29916

The labrum is a band of tough cartilage and connective tissue that lines the rim of the hip socket, or acetabulum. A hip labral tear involves the ring of soft elastic tissue that follows the outside rim of the socket of the hip joint. MRI exam can be performed to find any abnormality related to Hip labral tear. The physician performs surgery to repair the torn labrum. There are two types of labral tear. In type 1, the labrum is detached from the acetabular rim and is typically caused by a cam impingement. In type2 labral tear, the labrum is crushed against the neck of the femur, also called as pincer lesion. After determining the type of tear and it severity, the physician excises the torn piece of labrum or may debride or repair.

The physician performs an arthroscopic repair of the labrum, the cartilage that lines the rim of the acetabulum. Labral tears are often associated with femoroacetabular impingement (FAI). A primary, or type 1, labral tear is one in which the labrum is detached from the acetabular rim, and is typically caused by a cam impingement. A type 2 labral tear is most often caused by the labrum being crushed against the neck of the femur by an overhanging rim of the acetabulum, also known as a pincer lesion. With the patient under appropriate anesthesia, the hip is subluxed using leg traction to allow adequate visualization through the arthroscope. The physician creates portals through which an arthroscope and surgical instruments are inserted. Irrigation fluid is directed into each compartment of the joint using the arthroscope for visualization. After determining the type of tear and assessing its severity, the surgeon may excise the torn piece of labrum or may debride, trim, and repair it. The instruments are removed. A temporary drain may be placed, and the incisions are closed with Steri-strips and/or sutures.

Do not report CPT code 29914 and 29915 along with CPT code 29862 and 29863
Do not report CPT code 29916, along with CPT code 29915, 29862 and 29863.

Codes 29914, 29915, and 29916 represent procedures performed specifically for the treatment of femoroacetabular impingement (FAI). FAI is a condition in which the femoral head and acetabulum (the ball and socket) do not fit perfectly, causing friction during hip movements and resulting in damage within the hip joint. The damage can occur to the articular cartilage (the smooth white surface of the ball or socket) or the labral cartilage (the soft tissue that surrounds the socket).