Did you know that over 850,000 meniscus surgeries are performed annually in the U.S.? These critical orthopedic surgeries add direct costs of approximately 5 billion dollars each year to the health system.
CPT code 29880 is a procedural code that covers one such surgery of the knee joint. However, billing for this surgery demands industry knowledge and understanding of the bundling rules, global period, and varying payer policies.
Luckily, this guide will discuss all this and much more. So, if you are an orthopedist who often performs meniscus surgeries, continue reading!
CPT Code 29880 – Description
CPT code 29880 covers arthroscopic examination of the knee joint. It also involves meniscal shaving to remove torn and damaged meniscus from the lateral and medial compartments of the knee joint. Moreover, this procedural code includes reimbursement for chondroplasty, i.e., debridement or shaving of the damaged articular cartilage in the same or a separate compartment.
For context, arthroscopy (keyhole surgery) involves the use of an arthroscope (a tube-like instrument with a light and tiny camera) to see inside the joint and treat joint issues.
Appropriate Use Cases for CPT Code 29880
Let’s review some of the real-world clinical scenarios where CPT 29880 applies:
Traumatic Tear Requiring Dual Meniscectomy
Picture a 38-year-old male construction worker who has sustained a twisting injury to his knee. The MRI scan confirms a complex bucket-handle tear of the meniscus. Besides, there is an associated flap tear of the posterior horn of the lateral meniscus.
The orthopedist performs the arthroscopy and notes that both tears are irreparable. As a result, he performs a partial meniscectomy in both the lateral and medial compartments.
That’s not all, the orthopedic surgeon also addresses mild fraying of the articular cartilage on the patella.
Here, CPT code 29880 applies.
Dual Meniscectomy with Loose Body Removal
Consider a 51-year-old female patient with chronic mechanical knee symptoms. Her arthroscopy report reveals a flap tear of the lateral meniscus and a degenerative tear of the medial meniscus.
Thus, the orthopedic surgeon removes both through partial meniscectomy. Moreover, the orthopedist notes and removes a small synovial loose body from the joint space.
The orthopedic surgeon should report CPT code 29880 for bilateral meniscectomy. However, it does not cover the removal of the loose body. Thus, report it separately using the relevant procedural code (CPT 29875) and modifier 59 or one of its subsets for accurate coding and specificity.
Failed Meniscal Repair and Chondroplasty
Imagine a 39-year-old female patient who underwent a meniscal repair surgery six months ago. However, she still experiences persistent pain and a locking sensation.
The MRI scans revealed that the repair surgery failed. That is, the patient now has a new, symptomatic radial tear on the lateral side and a meniscal flap tear on the medial side.
Additionally, the orthopedic surgeon identifies an area of damaged articular cartilage on the medial femoral condyle.
Therefore, the provider performs a partial meniscectomy on both the medial and lateral sides. Besides, he conducts chondroplasty of the defect on the medial femoral condyle.
Here, CPT code 29880 applies.
Modifiers to Append with CPT Code 29880
Discussed below are all the applicable modifiers for CPT 29880:
Modifier 50
What happens when the orthopedic surgeon performs knee arthroscopy, covered under CPT code 29880, on both knees of the patient? You append modifier 50 to indicate that the healthcare provider rendered the same service on both sides of the patient’s body.
Modifier 51
Did the orthopedist perform two procedures during the same surgical session? If yes, do not forget to append modifier 51.
Here’s an example!
Assume a 42-year-old female athlete who sustains a severe knee injury. Arthroscopic evaluation confirms traumatic tears in both the medial and lateral menisci. Thus, the physician performs a partial meniscectomy on the medial and lateral compartments (CPT code 29880).
However, the injury also caused a complete avulsion of the medial collateral ligament. As a result, during the same session, the same healthcare provider also renders an open surgical repair (CPT 27405).
As per the CMS guidelines, modifier 51 is applicable.
Modifier 62
Modifier 62 represents that two healthcare practitioners worked together as co-surgeons. That is, each performed a distinct, non-overlapping part of the service and acted as the primary surgeon.
Modifiers 80, 81, 82 & AS
Before we explain these modifiers, note that these are specifically for assistant surgeons. Simply put, if you are a primary surgeon, you can skip this section.
For CPT code 29880, Medicare pays assistants at surgery. This is because the status indicator for this code under the ‘assistants at surgery’ field is 2. However, note that the supporting documentation must justify the need for an assistant surgeon.
The table below offers a brief overview of assistant at surgery modifiers:
| Modifier | Description |
|---|---|
| 80 | An assistant surgeon assisted the primary surgeon during the knee arthroscopy. |
| 81 | Minimal assistance at surgery was provided by another physician. |
| 82 | An assistant surgeon assisted at the surgery because a qualified resident was unavailable at a teaching hospital. |
| AS | A physician assistant (PA), nurse practitioner (NP), or clinical nurse specialist (CNS) assisted at the knee arthroscopy surgery. |
Modifier LT
If the surgeon renders the service covered under CPT code 29880 on the left knee of the patient, use modifier LT.
Modifier RT
It indicates that the orthopedist performed the knee arthroscopy surgery on the right knee of the patient.
Reimbursement Guidelines for CPT Code 29880
Discussed below are the essential billing requirements for CPT 29880:
Do NOT Bill 29880 For Removing the Meniscus From Either Medial or Lateral Compartments
The CPT code 29880 descriptor clearly states to cover the removal of meniscus from the medial AND lateral compartments of the knee joint. Therefore, if the physician performs meniscus shaving on either one of the compartments (medial or lateral), you cannot report it.
The reason is SIMPLE, there is another more specific procedural code available, i.e., CPT 29881.
Fulfill the Documentation Requirements
Detailed documentation is a key requirement for CPT code 29880. The following is a brief checklist to ensure you do not miss anything important:
For Justifying Medical Necessity
Your documentation must support why the knee arthroscopy surgery was performed. Thus, include the following:
- Details related to the preoperative diagnosis, e.g., complex radial tear of the lateral meniscus, grade III, etc.
- The patient’s medical records must confirm the failure of conservative treatment, e.g., anti-inflammatory medications, physical therapy, etc.
- Attach and reference to diagnostic evidence, e.g., MRI scans, etc., indicating a surgical tear.
For Surgeon’s Operative Notes
The orthopedist’s surgical report should confirm that he performed everything that the CPT code 29880 descriptor covers:
- Explain that the orthopedic surgeon entered and inspected all three compartments (lateral, medial, and patellofemoral).
- Mention the location, type, and extent of the tear in both the lateral and medial meniscus.
- Explicitly state that the surgeon performed ‘meniscectomy’ or ‘resection/removal’ of the torn portions of both menisci.
- Specify the location and grade of the chondral damage (if chondroplasty was rendered).
Understand the Global Period
CPT code 29880 has a 90-day global period. As a result, the healthcare provider’s postoperative orders and discharge summary must align with it.
Final Thoughts on CPT Code 29880
Phew! So many details to follow through. Here’s a quick rundown:
CPT code 29880 covers a major knee arthroscopy surgery with a 90-day global period. It bundles reimbursement for arthroscopy examination, meniscus shaving of the lateral and medial compartments, and chondroplasty.
Some applicable modifiers for this procedural code include 50, 51, 62, 80, 81, 82, AS, LT, and RT. However, note that if you are appending any of these, your documentation must support their usage to reduce audit risks.
Hopefully, with these details, you will be able to ensure a clean claim submission for CPT 29880. But if you struggle, feel free to outsource orthopedic billing services to NeuraBill.
