Endoscopy/Arthroscopy - Netter's Atlas of Surgical Anatomy for CPT® Coding

Coding Atlas

For many procedures of the large joints, arthroscopy is performed more frequently than an open arthrotomy.

Injuries to smaller joints are increasingly being diagnosed/

treated with arthroscopic approaches. The number of portals made to access the joint does not affect code selection.

29800 Arthroscopy, temporomandibular joint, diagnostic, with or without synovial biopsy (separate procedure) 29804 Arthroscopy, temporomandibular joint, surgical 29805 Arthroscopy, shoulder, diagnostic, with or without

synovial biopsy (separate procedure)

29806 Arthroscopy, shoulder, surgical; capsulorrhaphy 29807 repair of SLAP lesion

29819 with removal of loose body or foreign body 29820 synovectomy, partial

29821 synovectomy, complete 29822 debridement, limited 29823 debridement, extensive

29824 distal claviculectomy including distal articular surface (Mumford procedure)

29825 with lysis and resection of adhesions, with or without manipulation

✚ 29826 decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (List separately in addition to code for primary procedure)

29827 with rotator cuff repair 29828 biceps tenodesis

29830 Arthroscopy, elbow, diagnostic, with or without synovial biopsy (separate procedure)

29834 Arthroscopy, elbow, surgical; with removal of loose body or foreign body

29835 synovectomy, partial 29836 synovectomy, complete 29837 debridement, limited 29838 debridement, extensive

29840 Arthroscopy, wrist, diagnostic, with or without synovial biopsy (separate procedure)

29843 Arthroscopy, wrist, surgical; for infection, lavage and drainage

29844 synovectomy, partial 29845 synovectomy, complete

29846 excision and/or repair of triangular fibrocartilage and/

or joint debridement

29847 internal fixation for fracture or instability

29848 Endoscopy, wrist, surgical, with release of transverse carpal ligament

29850 Arthroscopically aided treatment of intercondylar 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)

29860 Arthroscopy, hip, diagnostic with or without synovial biopsy (separate procedure)

29861 Arthroscopy, hip, surgical; with removal of loose body or foreign body

29862 with debridement/shaving of articular cartilage (chondroplasty), abrasion arthroplasty, and/or resection of labrum

29863 with synovectomy

# 29914 with femoroplasty (ie, treatment of cam lesion) # 29915 with acetabuloplasty (ie, treatment of pincer lesion) # 29916 with labral repair

29866 Arthroscopy, knee, surgical; osteochondral autograft(s) (eg, mosaicplasty) (includes harvesting of the autograft[s])

29867 osteochondral allograft (eg, mosaicplasty) 29868 meniscal transplantation (includes arthrotomy for

meniscal insertion), medial or lateral

29870 Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)

29871 Arthroscopy, knee, surgical; for infection, lavage and drainage

29873 with lateral release

29874 for removal of loose body or foreign body (eg, osteochondritis dissecans fragmentation, chondral fragmentation)

29875 synovectomy, limited (eg, plica or shelf resection) (separate procedure)

29876 synovectomy, major, 2 or more compartments (eg, medial or lateral)

29877 debridement/shaving of articular cartilage (chondroplasty)

Netter’s Atlas of Surgical Anatomy for CPT Coding

Musculoskeletal System

29800—29877

FIGURE 2-55. Knee Arthroscopy

In arthroscopic surgery, the knee is divided into three compartments: medial, lateral, and patello- femoral. Attention to documented compartments scoped during arthroscopy is essential to proper coding. For example, if a foreign body (FB) is removed from the medial compartment during another arthroscopic procedure within the medial compartment, removal of the FB would be considered as part of the larger procedure. However, if the FB is removed arthroscopically from the lateral compartment during a medial compartment arthroscopic procedure, FB removal may be reported separately. Note: Tools, implants, and/or equipment depicted in the illustration may be outdated but the procedural approach is valid.

Femur Articularis genus muscle

Quadriceps femoris tendon

Suprapatellar fat body

Suprapatellar (synovial) bursa Patella

Subcutaneous prepatellar bursa Articular cavity

Synovial membrane Patellar ligament Infrapatellar fat pad

Subcutaneous infrapatellar bursa Deep (subtendinous) infrapatellar bursa Lateral meniscus

Tibial tuberosity Lateral

subtendinous bursa of gastrocnemius muscle

Synovial membrane

Articular cartilages

Tibia Sagittal section

(lateral to midline of knee)

Anteromedial compartment

29879 abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture 29880 with meniscectomy (medial AND lateral, including

any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed

29881 with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed

29882 with meniscus repair (medial OR lateral) 29883 with meniscus repair (medial AND lateral)

29884 with lysis of adhesions, with or without manipulation (separate procedure)

29885 drilling for osteochondritis dissecans with bone grafting, with or without internal fixation (including debridement of base of lesion)

29886 drilling for intact osteochondritis dissecans lesion 29887 drilling for intact osteochondritis dissecans lesion

with internal fixation

29888 Arthroscopically aided anterior cruciate ligament repair/

augmentation or reconstruction

29889 Arthroscopically aided posterior cruciate ligament repair/

augmentation or reconstruction

29879—29889

Musculoskeletal System

Netter’s Atlas of Surgical Anatomy for CPT Coding

122 Moderate sedation ✚Add-on code ^Modifier 51 exempt #Resequenced code

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)

29893 Endoscopic plantar fasciotomy

29894 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with removal of loose body or foreign body 29895 synovectomy, partial

29897 debridement, limited 29898 debridement, extensive 29899 with ankle arthrodesis

29900 Arthroscopy, metacarpophalangeal joint, diagnostic, includes synovial biopsy

29901 Arthroscopy, metacarpophalangeal joint, surgical; with debridement

29902 with reduction of displaced ulnar collateral ligament (eg, Stenar lesion)

29904 Arthroscopy, subtalar joint, surgical; with removal of loose body or foreign body

29905 with synovectomy 29906 with debridement 29907 with subtalar arthrodesis

29914 Code is out of numerical sequence. See 29800-29999 29915 Code is out of numerical sequence. See 29800-29999 29916 Code is out of numerical sequence. See 29800-29999

Musculoskeletal System

29891—29907

Sphenoidal sinus

Frontal sinus Nasal cavity

Superior and supreme Middle Inferior

Nasal turbinates (conchae)

Nasal vestibule Ostium of auditory tube Oral cavity

Epiglottis Larynx

Vocal fold (cord) Trachea

Aorta

L. main bronchus

Pericardium Sternum (cut away) 6th and 7th costal cartilages

Diaphragm Diaphragmatic

parietal pleura Pericardial mediastinal pleura Hilus of

right lung Visceral pleura

over right lung R. main bronchus

Mediastinal parietal pleura

Cupula (dome) of pleura Esophagus Laryngopharnyx

(hypopharynx) Oropharynx

Nasopharynx

Pharynx

124

C H A P T E R 3

branching bronchioles further divide into alveoli, microscopic air sacs responsible for air exchange.

The lungs are dense with bronchi, bronchioles, and alveoli and also with a vascular system; air exchange is dependent on this system. Tiny capillaries wrap around the alveoli to make gas exchange efficient.

The lungs expand greatly during inspiration. To reduce friction in the thorax during inspiration and expiration, the lungs are lined in pleural membranes: the inner visceral pleura and outer parietal pleura. Between these membranes is lubricating fluid that allows the lungs to easily slide within the thorax. The lungs are not mirror images of one another. The right lung has three lobes, while the left lung has two because it shares space with the heart.

The respiratory system also houses the apparatus for sound production: the larynx. During expiration, air passes through the larynx, which contains vibratory cords that produce sound.

There are a significant number of respiratory disorders that are treated surgically. Because of its prominence on the face, the nose is often the site of impact in an injury. The septum dividing the nasal passages, the paired nasal bones, and local cartilage are all easily damaged.

Inflammation can cause hyperplasia in the sinuses, which can impede function. The lungs must be a closed system in order to operate properly and, like a balloon being blown up, will fail to inflate if there is a route for air to escape. This condition is called pneumothorax and can be treated surgically.

The proliferation of lumens in the lower respiratory system and network of cavities in the upper respiratory system are conducive to endoscopic approach. The codes for reporting this approach are integrated throughout the Respiratory System code set.

I n simplest terms, oxygen is required at the cellular level in order to produce energy from the food that we consume; this is similar to a fire needing oxygen in order to burn. The respiratory system transports oxygen from outside the body to the bloodstream, which carries it to individual cells throughout the body. The bloodstream also picks up an important waste product of energy production, carbon dioxide, and carries it back to the respiratory system. Each inspiration (breath in) delivers oxygen-rich air, and each expiration (breath out) removes carbon dioxide and other gaseous waste products from the body.

Air is drawn in through the nose or mouth and, as it travels, it is moistened and warmed in the nasal cavity.

Surrounding the nose are four paired sinuses: maxillary, frontal, sphenoid, and ethmoid. The sinuses are a bony framework covered in mucous membrane. Sinuses generate mucus that drains into the nasal structure through openings called ostia. Cilia on the surface of the epithelium of the sinuses and nose filter particles from incoming air. Mucus manufactured in the nose and sinuses collects what has been deposited on cilia, and movement of cilia transports the mucus toward the pharynx.

The pathways for air inhaled through the nose and mouth converge at the pharynx, which is divided into three parts: the nasopharynx, behind the nose and sinuses and above the soft palate; the oropharynx, behind the tongue and above the epiglottis; and the laryngopharynx, above the laryngeal inlet. The oropharynx is a conduit shared by digestive and respiratory systems. At the base of the oropharynx is the epiglottis, which serves as a valve to close the trachea during swallowing so that matter does not enter the lung.

The trachea connects to the right and left main bronchus.

These divide and subdivide like inverted trees. Small,

Respiratory System

125

Introduction

Coding Atlas

In displacement therapy, saline solution displaces infected sinus discharge, eg, pus, using pressure flow and suction.

A nasal septal button typically is secured over a hole in the nasal septum.

30200 Injection into turbinate(s), therapeutic 30210 Displacement therapy (Proetz type) 30220 Insertion, nasal septal prosthesis (button)

Dalam dokumen Netter's Atlas of Surgical Anatomy for CPT® Coding (Halaman 144-149)