Coding Guidance-Knee notchplasty with other major procedures

 Question: Our surgeon does the following procedures:

1. Lateral & medial meniscectomy

2. Intercondylar notch decompression using a burr

Can we bundle 29884 since it is a seperate procedure or use 59 since it is in the patella?

Answer: You report 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) for the lateral and medial meniscectomy. You may not be correct in reporting code 29884 (Arthroscopy, knee, surgical; with lysis of adhesions, with or without manipulation [separate procedure]) for the intercondylar notch decompression using a burr as a notchplasty is not the same as lysis of adhesions. There is no code for notchplasty and you will report 29999 (Unlisted procedure, arthroscopy).

Some coders might think to assign code 29877 (Arthroscopy, knee, surgical; debridement/shaving of articular cartilage [chondroplasty]), which describes arthroscopy with debridement/shaving of articular cartilage (chondroplasty).

Chondroplasty of the knee (also known as notchplasty) often is included in some of the larger knee procedures, it should not be reported. As per current CCI edits also, code 29877 is bundled into code 29880. The procedure is basically plastic surgery on cartilage (i.e., repair of lacerated or displaced cartilage), and many physicians perform this repair by removing torn or frayed articular cartilage.

Question: How should I code an arthroscopic notchplasty? The surgeon performed the procedure due to ACL graft impingement.

Answer: If the surgeon performs the notchplasty at the same time as an ACL reconstruction, you should not report the notchplasty separately.

You should report only 29888 (Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction) for ACL reconstructions. If the surgeon only performs notchplasty, use an unlisted-procedure code, such as 29999 (Unlisted procedure, arthroscopy). Although some coders use 29877 (Arthroscopy, knee, surgical; debridement/shaving of articular cartilage [chondroplasty]), this code describes shaving articular cartilage rather than the bone removal of notchplasty, so you should stick with the unlisted-procedure code. The surgeon performs notchplasty to enlarge the U-shaped notch that the ACL and PCL pass through. The notchplasty allows the ligaments to fit properly.