星空入口

Enhance your understanding of descriptor verbiage.

Orthopedic surgeons commonly perform ankle arthroscopy surgeries to treat a wide range of conditions that affect the ankle joint, including impingement, osteochondral defects, loose bodies, instability, cartilage damage, bone spurs, synovial inflammation, and acute injuries to the bones and ligament of the joint.

Read on to learn what the surgery entails and how to correctly report the procedure.

Check Out the Ankle Arthroscopy Codes

During an ankle arthroscopy, the surgeon examines and treats the ankle joint using a small camera and surgical instruments. The patient is placed under anesthesia and a series of small incisions are made around the ankle joint. The surgeon inserts the arthroscopic camera into the joint and fills the joint with sterile fluid to expand the space, so the can visualize the joint structures. Any structures in need of repair are treated using arthroscopic surgical instruments.

The CPT^庐 code set includes seven codes that describe various arthroscopic surgical procedures performed on the ankle:

• 29891 (Arthroscopy, ankle, surgical, excision of osteochondral defect of talus and/or tibia, including drilling of the defect)
• 29892 (Arthroscopically aided repair of large osteochondritis dissecans lesion, talar dome fracture, or tibial plafond fracture, with or without internal fixation (includes arthroscopy))
• 29894 (Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with removal of loose body or foreign body)
• 29895 (鈥� synovectomy, partial)
• 29897 (鈥� debridement, limited)
• 29898 (鈥� debridement, extensive)
• 29899 (鈥� with ankle arthrodesis)

When a surgeon performs an arthroscopic or endoscopic procedure on the ankle that is not described by an existing CPT^庐 code, you will report 29999 (Unlisted procedure, arthroscopy). An example of a procedure that is reported with unlisted code 29999 is an endoscopic excision of the os trigonum.

Turn to Reference Materials for Coding Guidance

Coders should look to the CPT^庐 code set, CPT^庐 Assistant, CPT^庐 Vignettes, and the CPT^庐 Knowledge Base for guidance in proper reporting of ankle arthroscopy procedures.

In 2020, CPT^庐 issued revised guidelines for reporting arthroscopic removal of loose or foreign bodies. The revised guidelines tell you 29894 may be reported in addition to another ankle arthroscopy code only 鈥渨hen the loose body(ies) or foreign body(ies) is equal to or larger than the diameter of the arthroscopic cannula(s) used for the specific procedure, and can only be removed through a cannula larger than that used for the specific procedure or through a separate incision 鈥� or through a portal that has been enlarged to allow removal of the loose or foreign body(ies).鈥�

It is important that coders review revised reporting guidelines with their surgeons so that they include the required language in their documentation.

Confirm Code Descriptor Wording

Some of the terms in the ankle arthroscopy code descriptions that give coders pause are 鈥渓imited,鈥� 鈥渆xtensive,鈥� and 鈥渋ncluding.鈥�

Code 29891 indicates that the procedure includes drilling of the defect. Coders wonder if this means that drilling of the defect must be performed to report the code. The November 2023 CPT^庐 Knowledge Base clarified that the intent of 29891 鈥渨as not to require drilling of the defect or require acromioplasty, but to include it when performed.鈥� 

CPT^庐 codes 29897 and 29898 are reported for arthroscopic debridement of the ankle joint, but coders are often left scratching their heads trying to figure out what constitutes a limited debridement versus an extensive debridement. The December 2024 issue of CPT^庐 Assistant addressed this issue, advising that code selection is dependent on the details contained in the operative report. Without more specific guidance, it is important that the surgeon documents whether they performed a limited or extensive debridement.

Pay Attention to Payer Rules

When a Medicare beneficiary undergoes ankle arthroscopy, you must be aware of the applicable National Correct Coding Initiative (NCCI) edits and NCCI guidelines for arthroscopic procedures. You should understand that NCCI, which rules Medicare guidelines, does not allow 29897 or 29898 to be reported separately when the procedures are performed in conjunction with another arthroscopic procedure on the same ankle. This differs from CPT^庐 guidelines, which do not have this reporting restriction.

Take a look at an example where CPT^庐 and Medicare guidelines would lead to different reporting of the same procedures:

Scenario: A patient undergoes arthroscopic ankle surgery with limited debridement of chondromalacia of the talus and removal of a large loose body. The surgeon documents that they had to enlarge an arthroscopic portal in order to remove the loose body.

The surgeon has met the CPT^庐 criteria for reporting the loose body removal (29894) in addition to the arthroscopic limited debridement (29897). However, if the patient is a Medicare primary, you may report only 29894 because NCCI considers 29897 to be a column 2 component code of 29894. The NCCI guidelines do not allow arthroscopic debridement to be reported in conjunction with other arthroscopic procedures performed on the same joint.

Heidi Stout, CPC, COSC, President, Coder on Call, Inc.