Arthroscopy ICD-10 and CPT® Coding Changes: 3 General Principles

Arthroscopy is a less invasive method where an endoscope is placed inside the joint to perform diagnostic and therapeutic procedures. With the advancement of technology, procedures earlier performed by large incisions are now performed arthroscopically. Over the past few years in order to make room for this evolving technology, new arthroscopy, CPT® Category III codes, and HCPCS Level II codes, have emerged.

Arthroscopic coding involves three general principles:

  1. A procedure that starts arthroscopically and concludes open, is coded with the open procedure code only. For such situations, code with diagnosis code V64.43 Arthroscopic surgical procedure and later changed to open procedure to report the arthroscopic component.

For instance, a patient has an intra-articular fracture of the distal radius. The surgeon attempts arthroscopic reduction of the fracture fragments after synovial debridement for visualization. The surgeon discovers fragments that are not adequately mobile for arthroscopic reduction, and adapts to an open reduction and internal fixation of the three distal radial fragments. CPT® arthroscopy coding 25609. Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 3 or more fragments. The arthroscopic endeavour at reduction and synovectomy for visualization is included in the open completion of that procedure, as indicated by V64.43, which is also reported.

2. There are 7 CPT® codes that describe “arthroscopically aided” procedures. In other words, even though part of the procedure is performed open, the arthroscopic procedure codes should be assigned.

The codes are:

  • 29850: Arthroscopically aided treatment of intercodylar 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)
  • 29888: Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction
  • 29889: Arthroscopically aided posterior cruciate ligament repair/augmentation or reconstruction
  • 29892: Arthroscopically aided repair of large osteochondritis dissecans lesion, talar dome fracture, or tibial plafond fracture, with or without internal fixation (includes arthroscopy)

3. Diagnostic procedures for every arthroscopic ICD-10 code group are contained within any surgical procedures performed from that same group.

The groups are:

  • Temporomandibular (29800-29804)
  • Shoulder (29805-29828)
  • Elbow (29830-29838)
  • Wrist (29840-29847)
  • Hip (29860-29863)
  • Metacarpophalangeal joints (29900-29902)

Within these groups, the first code defines the diagnostic procedure and following codes describe surgical procedures. The code groups for the ankle (29891-29899) and the subtalar joints (29904-29907) do not involve diagnostic codes.

Note: There are 2 codes in this group that are not technically arthroscopies (that is, they are not endoscopies within a joint), but rather are musculoskeletal endoscopies.

For more on current trends in ICD-10 arthroscopy coding and reimbursement join expert speaker Lynn M. Anderanin in this Live Audio Conference. This session will cover several commercial carrier and Medicare policies that affect arthroscopies helping you to stay in the right direction for clean claims. It will also help you keep with updated with ICD-10 arthroscopy coding and CPT® arthroscopy coding changes.

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