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February 13, 2012

Coding for Arthroscopic Knee Surgery
For The Record
Vol. 24 No. 3 P. 28

Arthroscopy is a minimally invasive procedure performed through a small incision by inserting a small camera hooked to a television monitor. It provides a clear view inside the joint so the surgeon can definitively diagnose the condition. Treatment can also occur through the arthroscope by creating additional small incisions and inserting instruments such as scissors, shavers, or lasers. Almost all arthoscopic procedures are done on an outpatient basis.

Arthroscopy is classified to ICD-9-CM subcategory 80.2. A fourth digit is required to identify the joint being scoped. A code from this subcategory is assigned when it is the only procedure performed (eg, diagnostic procedure). If a more definitive procedure is done at the same time, a code for the arthroscopic approach is not assigned. According to Coding Clinic, surgical approaches (eg, scopes) are not coded if a more definitive procedure is performed. Therefore, if a procedure was done via a scope, assign a code for the procedure (open) performed until specific codes for the arthroscopic approach are created, but do not assign a separate code for the scope (AHA Coding Clinic for ICD-9-CM, 1993, first quarter, page 23).

Some common knee injuries include the following:

Sprain: This occurs when one or more ligaments in the knee is suddenly stretched or torn. There are four knee ligaments: anterior cruciate, posterior cruciate, medial collateral, and lateral collateral.

Current sprains and strains of the knee are classified to category 844. The fourth digit will classify the ligament involved. A torn, ruptured, or detached ligament is also included in category 844. An old or chronic sprain or torn ligament is classified to subcategory 717.8. A fifth digit is required to identify the ligament involved.

Tearing of knee cartilage or meniscus: The wedge-shaped pieces of cartilage in the knee joint are called meniscus and act as shock absorbers. They can tear in different ways and are classified by how they look and where the tear occurs. Common current meniscus tears include the following:

• Medial meniscus/cartilage tear (836.0) includes bucket handle;

• Lateral meniscus/cartilage tear (836.1) includes bucket handle; and

• Tear of meniscus/cartilage (semilunar) not specified as medial or lateral (836.2).

Old or chronic meniscus tear is classified to category 717. The fourth and fifth digits identify the location and type of meniscus tear as follows:

• Old bucket handle tear of medial meniscus (717.0);

• Derangement of anterior horn of medial meniscus (717.1);

• Derangement of posterior horn of medial meniscus (717.2);

• Other and unspecified derangement of medial meniscus (717.3);

• Derangement of lateral meniscus, unspecified (717.40);

• Bucket handle tear of lateral meniscus (717.41);

• Derangement of anterior horn of lateral meniscus (717.42);

• Derangement of posterior horn of lateral meniscus (717.43);

• Other derangement of lateral meniscus (717.49); and

• Derangement of meniscus, not elsewhere classified (717.5).

Ruptured or detached meniscus goes to the same codes for tear of meniscus except that recurrent detachment of meniscus is classified to code 718.36, Recurrent dislocation of joint, lower leg.

If the documentation does not specify whether the tear or sprain is current or old, the code defaults to a current injury.

• Patellar subluxation/dislocation is classified to code 836.3 for closed dislocation and 836.4 for open dislocation.

• Patellofemoral syndrome (719.46) is anterior knee pain that increases during activities, especially those involving stair climbing, squatting, or kneeling. It is caused by irritation on the undersurface of the patella and leads to the loss of cartilage lining the bone of the joint (AHA Coding Clinic for ICD-9-CM, 2001, first quarter, pages 3-4).

Some common arthroscopic knee surgeries include the following:

• Lavage and debridement of the knee joint involves flushing or smoothing out floating or displaced tissue pieces and bone surfaces. This procedure is assigned to code 80.86 (AHA Coding Clinic for ICD-9-CM, 2008, first quarter, page 7).

• Trephination of meniscus is classified to code 81.47, Other repair of the knee (AHA Coding Clinic for ICD-9-CM, 2006, second quarter, page 13).

• Chondroplasty with debridement of meniscus is classified to code 81.47 (AHA Coding Clinic for ICD-9-CM, 2000, first quarter, page 13).

• Repair of torn meniscus (81.47)

• Repair/reconstruction of torn cruciate ligaments (81.45)

• Repair/reconstruction of torn collateral ligaments (81.46)

• Trimming of torn pieces of articular cartilage is classified to code 80.6, Excision of semilunar cartilage of knee.

• Meniscectomy (80.6), excision of meniscus of knee

• Synovectomy (80.76), complete or partial resection of synovial membrane

Nonarthroscopic knee procedures include the following:

• Realignment of patella (81.44)

• Osteochondral autograft/allograft transfer system (81.47)

Coding and sequencing for arthoscopic knee surgery are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to more than 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling 800-367-2447.


Coding for Arthroscopic Knee Surgery in ICD-10-PCS
In ICD-10-PCS, arthroscopy goes to the root operation “inspection,” which is defined as visually and/or manually exploring a body part. Therefore, an arthroscopy of the right knee is classified to code 0SJC4ZZ, and arthroscopy of the left knee is classified to code 0SJD4ZZ. The fifth character identifies the approach. Arthroscopy would be considered percutaneous endoscopic, which is defined as entry, by puncture or minor incision, of instrumentation through the skin or mucous membrane and any other body layers necessary to reach and visualize the site of the procedure.

According to the ICD-10-PCS Coding Guidelines for inspection procedures, do not code separately the inspection of a body part to achieve a procedure’s objective. In addition, when an inspection procedure and another procedure are performed on the same body part during the same operative episode, it is appropriate to assign the inspection code separately if there are different approaches for each procedure. However, if the approach is the same between the inspection procedure and the other procedure, only the code for the other procedure would be assigned.

— AH