Type of Procedure: Autologous chondrocyte implantation, knee
CPT Code(s): 27412
Procedure Description: Several weeks or months prior to this procedure, a biopsy specimen is
taken first from the patient, and sent out for cellular expansion of the graft. At the time of the graft
procedure, a bed is prepared at the defect to contain the graft, and a patch of periosteum is
harvested from the femur or tibia. This patch is carefully sewn into place on the defect to
maintain a watertight seal and the cultured chondrocyte material implanted. The remainder of the
pocket is then sealed with fibrin glue to ensure that no leakage of the cells occurs.
Integral Procedure(s): Since tissue graft, knee arthrotomy, exploration, removal of loose
bodies, and manipulation of the knee joint and fixation are included in chondrocyte implantation, a
new parenthetical note was added to indicate that code 27412 should not be reported in addition
to codes 20926, 27331, and 27570 at the same session. Evaluation of the cells for implantation
prior to the procedure is also inherent, and not separately reported.
Diagnostic Implications: This procedure is typically performed for the repair of lesions
of the femoral condyle, the patellofemoral joint and medial and lateral articular cartilage lesions of
the distal femoral condyles or trochlea.
Comments: (Source: CPT Changes: An Insider’s View 2005, AMA, Chicago, IL, 2004).
Coding Tips:


For harvesting of chondrocytes, use 29870
See HCPCS Level II code J7330 (autologous cultured chondrocyte implant) for the actual
supply of cultured chondrocytes.
Type of Procedure/CPT Codes:
29866
Arthroscopy, knee, surgical; osteochondral autograft(s) (eg, mosaicplasty)
(includes harvesting of the autograft)
29867
Arthroscopy, knee, surgical; osteochondral allograft (eg, mosaicplasty)
Procedure Description: Mosaicplasty is a resurfacing technique which consists of the mosaiclike transplantation of multiple, small-sized cylindrical osteochondral (bone and articular cartilage)
grafts to provide a smooth resurfaced area. In the case of the autograft procedure, the grafts are
harvested from the relatively less weight-bearing periphery of the patellofemoral joint and the
donor sites are repaired by the natural healing process and results in filling of the tunnels with
cancellous bone and coverage of the surface with reparative fibrocartilage. Small, varying sized
multiple cylindrical grafts provide almost complete coverage of the surface. If necessary,
fibrocartilage grouting, stimulated by abrasion arthroplasty or sharp curettage at the base of the
defect, may be performed to complete the new surface. In performance of the allograft and
autograft procedures, conical recipient tunnels are created in the defect into which the graft
material is delivered in a perpendicular fashion.
Integral Procedure(s): Do not report 29866 in conjunction with 29870, 29871, 29875, 29884
when performed at the same session and/or 29874, 29877, 29879, 29885-29887 when performed
in the same compartment. Do not report 29867 in conjunction with 27570, 29870, 29871,
29875, 29884 when performed at the same session and/or 29874, 29877, 29879, 29885-29887
when performed in the same compartment. Arthroscopic removal of foreign bodies (29874)
and/or debridement of shaving of articular cartilage (29877) is appropriately reported when
performed in a compartment other than the arthroscopic graft procedure. Osteochondritis
dissecans involves inflammation of a bone and its cartilage, complete or incomplete, separation
of a portion of joint cartilage and underlying bone, usually involving the knee and associated with
epiphyseal aseptic necrosis.
Diagnostic Implications: Insertion of the autografts and allografts is performed for the treatment
of chondral and osteochondral defects of the weight-bearing surfaces to create hyaline or
hyalinelike repair in the defect area, with the end result of transplanted hyaline cartilage with
fibrocartilage filling the donor sites.
Comments: (Source: CPT Changes: An Insider’s View 2005, AMA, Chicago, IL, 2004).
Coding Tips:


As this procedure typically requires the placement of multiple grafts, code 29866 is
reported one time per procedure, regardless of the number of grafts obtained and
inserted.
Harvest of the autograft is not reported separately in addition to 29866, as acquisition of
the graft is inherent in arthroscopic osteochondral autograft implantation.
Type of Procedure: Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy
for meniscal insertion), medial or lateral
CPT Code(s): 29868
Procedure Description: Arthroscopic meniscal knee transplantation consists of preparation of
the defect area with removal of the damaged portion of the meniscus - the crescent-shaped
fibrocartilaginous structure of the tibial plateau of the knee. Tibial tunnels or a bone trough are
then created as stabilizing structures for the implant. The meniscal graft is then inserted through
an arthrotomy and secured to the stabilizing structures. Arthrotomy performed for meniscal
insertion as an inherent component of the procedure should not be separately reported.
Integral Procedure(s): Do not report 29868 in conjunction with 29870, 29871, 29875, 29880,
29883, 29884 when performed at the same session or 29874, 29877, 29881, 29882 when
performed in the same compartment. Arthroscopic removal of foreign bodies (29874) and/or
debridement of shaving of articular cartilage (29877) is appropriately reported when performed in
a compartment other than the arthroscopic graft procedure.
Diagnostic Implications: Damaged meniscus.
Comments: (Source: CPT Changes: An Insider’s View 2005, AMA, Chicago, IL, 2004).
Type of Procedure: Lavage and drainage
CPT Code: 29871
Procedure Description: Irrigation or washing out of the knee arthroscopically and subsequent
drainage of any substances put into the knee.
Integral Procedure(s): closure of wound and repair of tissues divided for initial surgical
exposure, partial or complete; application of initial dressing, orthosis, continuous passive motion,
splint or cast, including traction; preparation and insertion of synthetic bone substitutes (e.g.,
hydroxyapatite, coral, methylmethacrylate, demineralized bone matrix); minor synovial resection
for visualization; incidental removal of loose or foreign bodies or surgical debris through a sheath;
diagnostic knee arthroscopy; additional portal(s) or enlarging portal(s); arthroscopically aided
tibial fracture treatment.
Diagnostic Implications: Infection (i.e., septic joint); very arthritic knee
Comments: NA
Type of Procedure: Lateral Release
CPT Code: 29873
Procedure Description: Arthroscopic lateral release is a procedure performed to correct
problems with the patella (kneecap).
Tracking is the term used to describe the movement of the patella with the knee. Lateral release
is performed when the patella becomes misaligned and does not track properly. Tightness in the
lateral retinaculum, a tissue in the knee similar to rawhide, usually causes this condition. Some
patients have a genetic predisposition to retinacular tightness and laterally riding patellae. Other
patients misalign their patellae with a twisting injury or a blow to the kneecap. When the patellae
are injured in this way, the retinaculum shrinks and gets tough, which causes the kneecap to fall
off track.
Lateral release involves cutting the tight lateral ligaments to allow for normal tracking of the
patella. The orthopedic surgeon first makes a small incision in the retinaculum through the
arthroscope. He then cuts the tight ligaments on the outside (lateral side) of the patella to allow it
to slide toward the center of the femoral groove. These ligaments eventually heal with scar tissue
that fills in the gap created by the surgery.
Integral Procedure(s): closure of wound and repair of tissues divided for initial surgical
exposure, partial or complete; application of initial dressing, orthosis, continuous passive motion,
splint or cast, including traction; preparation and insertion of synthetic bone substitutes (eg,
hydroxyapatite, coral, methylmethacrylate, demineralized bone matrix); synovial resection for
visualization; diagnostic knee arthroscopy; knee lavage and/or drainage; manipulation under
anesthesia. NOTE: Arthroscopic removal of loose or foreign bodies greater than 5 mm and/or
through separate incision is not included and can be reported separately if performed.
Diagnostic Implications: Tight lateral retinaculum.
Comments/Coding Tip:
Code 27425 is reported for open lateral retinacular release, code 29873 is reported for
arthroscopic lateral release.
Type of Procedure: Removal of loose body or foreign body
CPT Code: 29874
Procedure Description: Arthoscopic removal of a loose body (bony or articular cartilaginous
fragment floating around in the knee); this can be pulled out with a grasper (similar to a pair of
pliers) or chopped up and suctioned out with a motorized shaver (a long, hollow tube with a
rotating blade and window on the end). A grasper would be used primarily to remove a screw,
bullet, staple, metal hardware, etc., because a motorized shaver could not be used to chop up a
metallic foreign body. If the loose body is large, an osteotome may be used to break it up so that
it can be removed in pieces.
Integral Procedure(s): closure of wound and repair of tissues divided for initial surgical
exposure, partial or complete; application of initial dressing, orthosis, continuous passive motion,
splint or cast, including traction; preparation and insertion of synthetic bone substitutes (e.g.,
hydroxyapatite, coral, methylmethacrylate, demineralized bone matrix; minor synovial resection
for visulation; articular shaving, debridement, and /or chondroplasty in the SAME compartment
(medial, lateral, patellar femoral); diagnostic knee arthroscopy; additional portal (s) or enlarging
portal(s).
Diagnostic Implications: Loose bodies: osteochondral fracture in which the subchondral bone
is cracked and a piece breaks off (usually due to trauma where the patella is dislocated, twisting
injuries, ligament tears); arthritis
Foreign bodies: bullets; broken hardware (e.g., screw, staple) that was inserted to repair a
ligament, fracture or osteochondritis dissecans; broken surgical instrument (e.g., something not
normally found in the knee)
Comments: A foreign body can be a loose body. For example, a screw can dislodge and float
around in the knee, in which case it is a loose body.
Coding Tips:

For Medicare hospital outpatients- report code G0289 for an arthroscopic knee with
removal of loose body, foreign body, debridement/shaving of articular cartilage
(chondroplasty) at the time of other surgical knee arthroscopy in a different compartment
of the same knee.

Code G0289 is an add-on code and should be added to the knee arthroscopy code for
the major procedure being performed. This code is only to be reported once per extra
compartment, even if chondroplasty, loose body removal, and foreign body removal are
all performed.

Code G0289 may be reported twice (or with a unit of two) if the physician performs these
procedures in two compartments in addition to the compartment where the main
procedure was performed.

Code G0289 should be reported only when the physcian spends at least 15 minutes in
the additional compartments performing the procedure. It should not be reported if the
reason for performing the procedure is due to a problem caused by the arthroscopic
procedure itself.

Per CMS, code GO289 is to be used when a procedure is performed in the lateral,
medial, or patellar compartments in addition to the main procedure.

CMS will not allow billing of CPT codes 29874 (arthroscopic removal of loose/foreign
body) and 29877 (arthroscopic chondroplasty) with other arthroscopic procedures on the
same knee.
Source: August 2001 CPT Assistant newsletter, AMA:

If a knee arthroscopy for removal of loose or foreign bodies (29874) is performed in the
same knee compartment as procedures described by codes 29875–29881, then code
29874 should not be reported separately as this is considered to be an inclusive
component of codes 29875–29881.

However, if a knee arthroscopy for removal of loose or foreign bodies (29874) is
performed in a different knee compartment as the knee arthroscopy procedure codes
29875–29881, then code 29874 may be reported separately with distinct procedural
service modifier –59 appended. For example, when smoothing down the cartilage and/or
drilling holes to create microfractures is also performed in addition to removal of foreign
bodies or loose bodies of the bone or cartilage within the knee joint, code 29879 may be
reported in addition to code 29874 only if performed in a separate knee compartment.
Modifier –59 should be appended to indicate that a separate compartment was involved.
Type of Procedure: Limited synovectomy (e.g., plica or shelf resection)
CPT Code: 29875
Procedure Description: Arthroscopic removal of plica or shelf (i.e., extensions of the synovium
in the knee capsule) by using a motorized shaver that sucks the joint lining into the end of the
shaver where a sharp blade amputates it (e.g., KAM Super Sucker).
Integral Procedure(s): closure of wound and repair of tissues divided for initial surgical
exposure, partial or complete; application of initial dressing, orthosis, continuous passive motion,
splint or cast, including traction; preparation and insertion of synthetic bone substitutes (e.g.,
hydroxyapatite, coral, methylmethacrylate, demineralized bone matrix); minor synovial resection
for visualization; incidental removal of loose bodies or surgical debris through a sheath,
diagnostic knee arthroscopy; additional portal(s) or enlarging portal(s).
Diagnostic Implications: Meniscal tear; arthritis
Comments: About 99 percent of the time, synovium is excised because it obstructs the
surgeon’s view when another procedure is being performed
Plica or shelf is the band of tissue rubbing back and forth over the end of the bone that may
become inflamed; it is an embryologic remnant of a septum or wall that is in the joint of 40 to 60
percent of humans.
Synovium - the lining of the joint is mainly responsible for making joint fluid. If the knee becomes
inflamed with debris, the synovium becomes inflamed and thickened, produces excess fluid and
leads to "water on the knee" or joint effusion.
Coding Tip:

It is important to note that both codes 29875 and 29876 should not be reported together,
since the limited synovectomy (29875) is considered to be an inclusive component of the
major synovectomy (29876), as the descriptor of code 29876 states that the major
synovectomy involves two or more compartments. (Source: August 2001 CPT Assistant
newsletter, AMA).
Type of Procedure: Major synovectomy, two or more compartments (e.g., medial or lateral)
CPT Code(s): 29876
Procedure Description: Arthroscopic removal of synovium, using a motorized shaver, from
more than one of the following compartments of the knee: suprapatellar pouch - a separate
compartment located at the knee cap on the top of the knee; medial compartment - includes the
medial femoral condyle, medial tibial plateau and medial meniscus; lateral compartment includes the lateral femoral condyle, lateral tibial plateau and the lateral meniscus; intercondylar
notch - between the medial and lateral compartments (there are posterior medial compartments
and posterior lateral compartments, which are spaces between the posterior femoral condyles
and posterior capsule).
Integral Procedure(s): closure of wound and repair of tissues divided for initial surgical
exposure, partial or complete; application of initial dressing, orthosis, continuous passive motion,
splint or cast, including traction; preparation and insertion of synthetic bone substitutes (e.g.,
hydroxyapatite, coral, methylmethacrylate, demineralized bone matrix); minor synovial resection
for visualization; diagnostic knee arthroscopy; additional portal(s) or enlarging portal(s); knee
lavage and/or drainage. NOTE: removal of loose or foreign bodies through separate incision is
not included and can be reported separately if performed.
Diagnostic Implications: Rheumatoid arthritis (synovium becomes so inflamed that it "eats
away" at the cartilage and bone); synovial proliferative disorders (the synovium becomes
inflamed independently of another disorder); chronic synovitis for more than six months that has
been unresponsive to treatment; pigmented villonodular synovitis
Comments: A major synovectomy is a tedious procedure that can take hours to perform, unlike
the relatively brief limited synovectomy procedure.
Type of Procedure: Debridement/shaving (chondroplasty) of articular cartilage
CPT Code: 29877
Procedure Description: Arthroscopic use of a motorized shaver to resect or debride
irregularities of articular cartilage - the gristly, white, rubbery cap on the end of a bone found in
the major joints (knee, shoulder, hip) where the ends of the bones touch each other
Integral Procedure(s): closure of wound and repair of tissues divided for initial surgical
exposure, partial or complete; application of initial dressing, orthosis, continuous passive motion,
splint or cast, including traction; preparation and insertion of synthetic bone substitutes (e.g.,
hydroxyapatite, coral, methylmethacrylate, demineralized bone matrix); removal of osteochondral
and/or chondral bodies (attached); diagnostic knee arthroscopy; additional portal(s) or enlarging
portal(s); synovectomy. NOTE: removal of loose or foreign bodies through separate incision is
not included and can be reported separately if performed.
Diagnostic Implications: Early arthritis; arthritic chondyle; chondral fracture; chondromalacia
Comments: Coding Tips

For Medicare hospital outpatients- report code G0289 for an arthroscopic knee with
removal of loose body, foreign body, debridement/shaving of articular cartilage
(chondroplasty) at the time of other surgical knee arthroscopy in a different compartment
of the same knee.

Code G0289 is an add-on code and should be added to the knee arthroscopy code for
the major procedure being performed. This code is only to be reported once per extra
compartment, even if chondroplasty, loose body removal, and foreign body removal are
all performed.

Code G0289 may be reported twice (or with a unit of two) if the physician performs these
procedures in two compartments in addition to the compartment where the main
procedure was performed.

Code G0289 should be reported only when the physcian spends at least 15 minutes in
the additional compartments performing the procedure. It should not be reported if the
reason for performing the procedure is due to a problem caused by the arthroscopic
procedure itself.

Per CMS, code GO289 is to be used when a procedure is performed in the lateral,
medial, or patellar compartments in addition to the main procedure.

CMS will not allow billing of CPT codes 29874 (arthroscopic removal of loose/foreign
body) and 29877 (arthroscopic chondroplasty) with other arthroscopic procedures on the
same knee.


If "notchplasty" is performed during an arthroscopic knee procedure, use code 29877.
In order to separately report arthroscopic debridement/shaving of articular cartilage
(29877) and arthroscopic meniscectomy (29880, 29881) performed at the same session,
the procedure must be performed in separate compartments of the knee. Appending the
–59 modifier to the second procedure will communicate that the procedures were
performed in separate compartments of the knee. (Sources: CPT Assistant newsletters,
June 1999, page 11; April 2005.).

Code 29877 should be reported only one time, regardless of how many areas are
debrided or shaved. (Source: August 2001 CPT Assistant newsletter, AMA).
Type of Procedure: Abrasion arthroplasty or multiple drilling or micro fracture
CPT Code: 29879
Procedure Description: Arthroscopic removal of any remnants of articular cartilage left inside
the knee is performed first to leave a bony surface. Then, an abrader or burr is used to remove a
very thin layer of dead bone to access an area of bleeding bone. Multiple holes may be drilled
into the middle of the bone to activate more blood vessels and induce scab formation on the
bone. The purpose of scab formation is to patch the articular cartilage of the bone (without which
the joint fluid would prevent normal bone healing by washing the scab formation away), activate
more blood vessels and induce scab formation on the bone.
Integral Procedure(s): closure of wound and repair of tissues divided for initial surgical
exposure, partial or complete; application of initial dressing, orthosis, continuous passive motion,
splint or cast, including traction; preparation and insertion of synthetic bone substitutes (e.g.,
hydroxyapatite, coral, methylmethacrylates, demineralized bone matrix); removal of
osteochondral and/or chondral bodies (attached); diagnostic knee arthroscopy; additional
portal(s) or enlarging portal(s); articular shaving debridement, and/or chondroplasty. NOTE:
removal of loose or foreign bodies through separate incision is not included and can be reported
separately if performed.
Diagnostic Implications: Severe/end-stage arthritis; osteoarthritis; osteochondral fracture
Comments: Code 29877 describes debridement of articular cartilage that is partially gone; in the
abrasion arthroplasty procedure, the articular cartilage cap is completely gone.
Coding Tip:

Code 29879 includes chondroplasty performed as part of the abrasion arthroplasty, so
code 29877 should not be separately reported. If, however, chondroplasty is performed
in a separate knee compartment, then code 29877 may be reported separately. Distinct
procedural service modifier –59 should be appended to indicate that a separate
compartment was involved. This code also includes resection of osteophyte and removal
of loose or foreign bodies when performed in the same compartment. (Source: August
2001 CPT Assistant newsletter, AMA).
Type of Procedure: Medial and lateral meniscectomy
CPT Code: 29880
Procedure Description: Arthroscopic partial or total resection of both the medial (located on the
inner side of the knee) and lateral (located on the outer side of the knee) meniscus. A basket
forceps (used to remove a portion of the meniscus), motorized shaver, scissors or knives may be
used to resect the meniscus.
Integral Procedure(s): closure of wound and repair of tissues divided for initial surgical
exposure, partial or complete; application of initial dressing, orthosis, continuous passive motion,
splint or cast, including traction; preparation and insertion of synthetic bone substitutes (e.g.,
hydroxyapatite, coral, methylmethacrylate, demineralized bone matrix); articular shaving,
debridement, and/or chondroplasty in the SAME compartments; plica and/or synovial resection;
debridement and/or shaving of meniscus; debridement and/or shaving of cruciate stump;
meniscal tissue removal; diagnostic knee arthroscopy; additional portal(s) or enlarging portal(s);
knee lavage and/or drainage. NOTE: removal of loose (non-meniscal) or foreign bodies through
separate incision is not included and can be reported separately if performed.
Diagnostic Implications: Medial and lateral meniscal tears are common in the elderly and in an
anterior cruciate ligament tear.
Comments: Presently, orthopaedic surgeons try to repair the meniscus first, and the major
indication for removing it is a meniscal tear that is not repairable.
Coding Tips:

Assign code 29880 if a bilateral meniscectomy is performed on the same knee (both a
medial and a lateral meniscectomy are performed on the same knee).

In order to separately report arthroscopic debridement/shaving of articular cartilage
(29877) and arthroscopic meniscectomy (29880, 29881) performed at the same session,
the procedure must be performed in separate compartments of the knee. Appending the
–59 modifier to the second procedure will communicate that the procedures were
performed in separate compartments of the knee. (Sources: CPT Assistant newsletters,
June 1999, page 11; April 2005).
Type of Procedure: Medial or lateral meniscectomy (also see code 29880 above)
CPT Code: 29881
Procedure Description: Arthroscopic partial or total resection of either the medial or lateral
meniscus
Integral Procedure(s): closure of wound and repair of tissues divided for initial surgical
exposure, partial or complete; application of initial dressing, orthosis, continuous passive motion,
splint or cast, including traction; preparation and insertion of synthetic bone substitutes (e.g.,
hydroxyapatite, coral, methylmethacrylate, demineralized bone matrix); articular shaving,
debridement, and/or chondroplasty in the SAME compartment; plica and/or synovial resection;
debridement and/or shaving of meniscus; debridement and/or shaving of cruciate stump;
meniscal tissue removal; diagnostic knee arthroscopy; additional portal(s) or enlarging portal(s);
knee lavage and/or drainage. NOTE: removal of loose (non-meniscal) or foreign bodies through
separate incision is not included and can be reported separately if performed.
Diagnostic Implications: Meniscal tear
Comments: It takes an orthopaedic surgeon twice as long to perform a medial and lateral
meniscectomy as opposed to a medial meniscectomy or lateral meniscectomy.
Coding Tips:

See code 27347 for open excision of knee lesion of meniscus or capsule (e.g., cyst,
ganglion).

In order to separately report arthroscopic debridement/shaving of articular cartilage
(29877) and arthroscopic meniscectomy (29880, 29881) performed at the same session,
the procedure must be performed in separate compartments of the knee. Appending the
–59 modifier to the second procedure will communicate that the procedures were
performed in separate compartments of the knee. (Sources: CPT Assistant newsletters,
June 1999, page 11; April 2005).

From a CPT coding perspective, it would be appropriate to report meniscectomy code
29881 in addition to anterior cruciate ligament (ACL) repair code 29888, as the
meniscectomy is not considered an integral component of the ACL repair/reconstruction.
Source: October 2003 CPT Assistant newsletter, AMA.
Type of Procedure: Medial or lateral meniscus repair
CPT Code(s): 29882
Procedure Description: Arthroscopic repair of the medial or lateral meniscus is performed by
making an additional incision on the side of the knee, with passing sutures (either from inside the
knee outward or outside the knee inward) through the tear in the meniscal cartilage and then
tying a knot over it. This stitch holds the torn meniscal cartilage in place. The additional incision
is made to allow passage of the needles (to insert the sutures) through the cartilage in back of the
knee, without injury to the blood vessels and nerves in that area.
Integral Procedure(s): closure of wound and repair of tissues divided for initial surgical
exposure, partial or complete; application of initial dressing, orthosis, continuous passive motion,
splint or cast, including traction; preparation and insertion of synthetic bone substitutes (e.g.,
hydroxyapatite, coral, methylmethacrylate, demineralized bone matrix); articular shaving,
debridement, and/or chondroplasty in the SAME compartment; plica and/or synovial resection;
debridement and/or shaving of meniscus; debridement and/or shaving of cruciate stump;
meniscal tissue removal, same meniscus; diagnostic knee arthroscopy; additional portal(s) or
enlarging portal(s). NOTE: removal of loose (non-meniscal) or foreign bodies through separate
incision is not included and can be reported separately if performed.
Diagnostic Implications: This meniscal tear is repairable and has the ability to heal. Tears that
are located on the periphery of the meniscus will heal, if no other tears are associated with it. If
the tear is on the inner side, toward the middle of the knee, it will not heal because the blood
vessels do not circulate to this area completely.
Comments: Meniscal repair is much more complicated than meniscal excision (meniscectomy).
Coding Tip: Some surgeons state in an operative report that they performed a meniscal repair
when they may really mean a meniscectomy. The operative report should include some
description of sutures being placed into the meniscus if there was actually a repair.
Type of Procedure: Medial and lateral meniscus repair (also see code 29882 above)
CPT Code: 29883
Procedure Description: Arthroscopic repair of both the medial and lateral menisci
Integral Procedure(s): closure of wound and repair of tissues divided for initial surgical
exposure, partial or complete; application of initial dressing, orthosis, continuous passive motion,
splint or cast, including traction; preparation and insertion of synthetic bone substitutes (e.g.,
hydroxyapatite, coral, methylmethacrylate, demineralized bone matrix); articular shaving,
debridement, and/or chondroplasty in the SAME compartment; plica and/or synovial resection;
debridement and/or shaving of meniscus; debridement and/or shaving of cruciate stump;
meniscal tissue removal; diagnostic knee arthroscopy; additional portal(s) or enlarging portal(s).
NOTE: removal of loose (non-meniscal) or foreign bodies through separate incision is not
included and can be reported separately if performed.
Diagnostic Implications: See code 29882 above.
Comments: See code 29882 above.
Type of Procedure: Lysis of adhesions (with or without manipulation)
CPT Code: 29884
Procedure Description: Arthroscopic removal of adhesions, cutting and removal of fibrous
bands or scar tissue; scope is removed, and the knee is manipulated (forcefully bent or
straightened) to induce motion in the knee.
Integral Procedure(s): closure of wound and repair of tissues divided for initial surgical
exposure, partial or complete; application of initial dressing, orthosis, continuous passive motion,
splint or cast, including traction; preparation and insertion of synthetic bone substitutes (e.g.,
hydroxyapatite, coral, methylmethacrylate, demineralized bone matrix); minor synovial resection
for visualization; synovectomy; incidental removal of loose bodies and/or surgical debris through
a sheath; diagnostic knee arthroscopy; additional portal(s) or enlarging portal(s).
Diagnostic Implications: Postoperative complication after ligament reconstruction or total knee
replacement; status post intra-articular fracture; flexion contractions; extension contractions
Comments: In the past, manipulations of the knee were performed first due to the difficulty of
inserting the scope through the knee adhesions; however, studies found that this caused knee
damage before the adhesions could be viewed through the scope.
Coding Tip:

Code 29884 is designated as a separate procedure. Therefore, it should not be reported
separately when performed in addition to another major knee procedure, as it would be
considered an integral component. (Source: August 2001 CPT Assistant newsletter,
AMA).
Type of Procedure: Drilling for osteochondritis dissecans with bone grafting with or without
internal fixation (including debridement of base of lesions)
CPT Code: 29885
Procedure Description: The arthroscope is inserted into the knee to visualize the dissecans
fragment, and a pin is used to drill multiple holes through the articular cartilage into the diseased
and the normal part of the bone. The drilling develops tunnels so that blood vessels can grow
down into and replace the dead bone with living tissue and thus promote healing. Pegs of bone
graft (usually taken from the proximal tibia at end of the femur or hip) then are packed into these
holes. Screws (internal fixation) then may be placed through the dissecans fragment to compress
it and to promote healing. If both bone grafting and internal fixation are used, the bone grafts are
packed in from above the dissecans fragment, and the screws are inserted from below.
Integral Procedure(s): closure of wound and repair of tissues divided for initial surgical
exposure, partial or complete; application of initial dressing, orthosis, continuous passive motion,
splint or cast, including traction; preparation and insertion of synthetic bone substitutes (e.g.,
hydroxyapatite, coral, methylmethacrylate, demineralized bone matrix); minor synovial resection
for visualization; articular shaving, debridement, and/or chondroplasty in the SAME compartment;
loose body removal; diagnostic knee arthroscopy; additional portal(s) or enlarging portal(s).
Diagnostic Implications: Osteochondritis dissecans is similar to an osteochondral fracture in
which a piece of bone with its overlying cartilage cap separates from the end of the femur/knee.
The entire unit of cartilage and bone fragment may become separated and become a loose body
inside of the knee, or the bone may crack without disruption in the articular cartilage cap. This
condition may be congenital or caused by trauma (e.g., fracture), in which case there is blood
loss to a segment of bone that causes the bone to die underneath the cartilage. Usually, bone
grafting is used when there is an excessive amount of dead bone or the disorder is a chronic
problem.
Comments: In juveniles, osteochondritis dissecans may heal spontaneously and usually can be
treated with crutches and bracing; in adults, the prognosis is poorer.
Coding Tip: It may be necessary to assign a separate code if the bone graft is taken from the
patient’s hip (20900 or 20902) or from a bone bank (20999).
Type of Procedure: Drilling for intact osteochondritis dissecans lesion (also see code 29885
above)
CPT Code: 29886
Procedure Description: The arthroscope is inserted into the knee to visualize the dissecans
fragment, and a pin is used to drill multiple holes through the articular cartilage into the diseased
and the normal part of the bone. The drilling is performed to develop tunnels for blood vessels to
grow down into and reinvade the dead bone with living tissue to promote healing.
Integral Procedure (s): Closure of wound and repair of tissues divided for initial surgical
exposure, partial or complete; application of initial dressing, orthosis, continuous passive motion,
splint or cast, including traction; preparation and insertion of synthetic bone substitutes (e.g.,
hydroxyapatite, coral, methylmethacrylate, demineralized bone matrix); minor synovial resection
for visualization; articular shaving, debridement, and/or chondroplasty in the SAME compartment;
diagnostic knee arthroscopy; additional portal (s) or enlarging portal (s).
Diagnostic Implications: See code 29885 above.
Comments: See code 29885 above.
Type of Procedure: Drilling for intact osteochondritis dissecans lesions with internal fixation
(also see code 29885 above)
CPT Code: 29887
Procedure Description: The arthroscope is inserted into the knee to visualize the dissecans
fragment, and a pin is used to drill multiple holes through the articular cartilage into the diseased
bone and the normal part of the bone. The drilling is performed to develop tunnels for blood
vessels to grow into and reinvade the dead bone with living tissue and, thus, promote healing.
Screws are placed through the dissecans fragment to compress it.
Integral Procedure(s): closure of wound and repair of tissues divided for initial surgical
exposure, partial or complete; application of initial dressing, orthosis, continuous passive motion,
splint or cast, including traction; preparation and insertion of synthetic bone substitutes (e.g.,
hydroxyapatite, coral, methylmethacrylate, demineralized bone matrix); minor synovial resection
for visualization; articular shaving, debridement, and/or chondroplasty in the SAME compartment;
diagnostic knee arthroscopy; additional portal(s) or enlarging portal(s).
Diagnostic Implications: See code 29885 above.
Comments: See code 29885 above.
Type of Procedure: Arthroscopically aided anterior cruciate ligament repair/augmentation or
reconstruction
CPT Code: 29888
Procedure Description: An anterior cruciate ligament attaches onto the anterior portion of the
tibia. (A ligament holds two bones to each other, and a tendon attaches a muscle to a bone.)
The following methods may be used to correct a rupture or tear in the ligament.
Repair: Sutures or staples are placed into the injured anterior cruciate ligament to promote
healing. This procedure is not performed frequently (1 to 2 percent of time), and when it is
performed, it is often for a child or when the ligament is pulled right out of the bone and can be
placed back into it.
Augmentation: The injured anterior cruciate ligament is repaired as stated above, and a
hamstring tendon is run alongside the injured ligament as a splint.
Reconstruction: The remains of the injured anterior cruciate ligament are removed and replaced
with a patellar or hamstring tendon, allograft (donated tissue from a tissue bank) or a synthetic
ligament (not frequently used); this procedure is the most commonly performed procedure for the
anterior cruciate.
Integral Procedure(s): closure of wound and repair of tissues divided for initial surgical
exposure, partial or complete; application of initial dressing, orthosis, continuous passive motion,
splint or cast, including traction; preparation and insertion of synthetic bone substitutes (e.g.,
hydroxyapatite, coral, methylmethacrylate, demineralized bone matrix); minor synovial resection
for visualization; articular shaving, debridement, and/or chondroplasty; notchplasty; anterior
cruciate stump removal; synovectomy and fat pad resection; intra-articular ligament
reconstruction; harvesting and insertion of fascial, tendon, or bone graft; diagnostic knee
arthroscopy; additional portal(s) or enlarging portal(s); internal fixation of graft.
Diagnostic Implications: Anterior cruciate ligament rupture/tear
Comments: A "trick knee" can develop if a ligament is torn. Carbon fiber, Dacron tape, Gore
smoother cruciate tool and Zenotech are synthetic ligament materials.
Coding Tips:

Procedure code 29889 should not be used with reconstruction procedures 27427–27429.

Report code 29999 (unlisted procedure, arthroscopy) for arthroscopic debridement of the
anterior cruciate ligament (when no ACL repair is done). Source: "CPT 2000 Coding
Symposium" handout (AMA, Chicago, IL).

From a CPT coding perspective, it would be appropriate to report meniscectomy code
29881 in addition to anterior cruciate ligament (ACL) repair code 29888, as the
meniscectomy is not considered an integral component of the ACL repair/reconstruction.
Source: October 2003 CPT Assistant newsletter, AMA.
Type of Procedure: Posterior cruciate ligament repair/augmentation or reconstruction (also see
code 29888 above)
CPT Code: 29889
Procedure Description: A posterior cruciate ligament attaches to the posterior portion of the
tibia. (Also see code 29888 above.)
Integral Procedure(s): closure of wound and repair of tissues divided for initial surgical
exposure, partial or complete; application of initial dressing, orthosis, continuous passive motion,
splint or cast, including traction; preparation and insertion of synthetic bone substitutes (e.g.,
hydroxyapatite, coral, methylmethacrylate, demineralized bone matrix); minor synovial resection
for visualization; articular shaving, debridement, and/or chondroplasty; notchplasty; posterior
cruciate stump removal; synovectomy and fat pad resection; intra-articular ligament
reconstruction; harvesting and insertion of fascial, tendon, or bone graft; diagnostic knee
arthroscopy; additional portal(s) or enlarging portal(s); internal fixation of graft.
Diagnostic Implications: See code 29888 above.
Comments: See code 29888 above.
Coding Tips:

Procedure code 29889 should not be used with reconstruction procedures 27427–27429.

Report code 29909 (unlisted procedure, arthroscopy) for arthroscopic debridement of the
anterior cruciate ligament (when no ACL repair is done) Source: "CPT 2000 Coding
Symposium" handout (AMA, Chicago, IL).
Type of Procedures:
Arthroscopy, knee, surgical, implantation of osteochondral graft(s) for treatment of articular
surface defect; autografts
Arthroscopy, knee, surgical, implantation of osteochondral graft(s) for treatment of articular
surface defect; allografts
CPT Codes:
0012T
0013T
Description of Procedure: Osteochondral transplantation, the transfer of bone and articular
cartilage from a nonweight or minimally articulating area to a weight-bearing or often articulating
area, performed for the treatment of focal chondral and osteochondral articular defects, is a new
technique of arthroscopic osteochondral graft (vs. bone graft). Osteochondral transplantation is
designed to treat any disease, condition, or injury which results in a well demarcated geographic
lesion to the articular surface, but the most transplanted areas occur in the treatment of femoral
condylar symptomatic lesions of the weight-bearing, or patellar surfaces of the knee.
Three or four transplants may be harvested during the procedure, ranging in size from 4-12 mm
in diameter for autografts (0012T) and up to 3 cm for an allograft (0013T) implantation. A precise
tunnel is created through the exposed bone of the chondral defect perpendicular to the surface
with a drill inserted into the knee for exact fit of the implant. Proper alignment is assured of the
graft into the tunnel at the appropriate depth to restore a "normal" articular surface.
Integral Procedure(s): Arthroscopic implantation of an osteochondral autograft/allograft
includes diagnostic knee arthroscopy, synovial biopsy, lavage and drainage, lysis of adhesions,
drilling for osteochondritis dissecans with bone grafting and drilling the lesion. These procedures
are included procedures, and are not separately reported.
Coding Tips:





In the event that concurrent arthroscopic implantation of an osteochondral
autograft/allograft was performed to address a separate articular surface defect, codes
29885, 29886 and 29887 would be reported additionally with the modifier '-59' to indicate
the performance of a separate procedure.
Codes 0012T and 0013T were established to describe an osteochondral graft, not just a
bone graft, but that of an osteochondral “plug” and has strict and precise orientation for
its implantation.
Osteochondritis dissecans involves inflammation of a bone and its cartilage, complete
or incomplete, separation of a portion of joint cartilage and underlying bone, usually
involving the knee and associated with epiphyseal aseptic necrosis.
If open osteochondral transplantation procedures are performed, then assign unlisted
CPT code 27599 (unlisted procedure, femur or knee) for an open knee OAT procedure,
or unlisted CPT code 27899 (unlisted procedure, leg or ankle) for an open ankle OAT
procedure.
Do not assign codes 0012T or 0013T for the autologous cultured chondrocytes
implant therapy. This procedure provides temporary relief from knee pain. The
autologous cultured procedure repairs the injured cartilage by implanting the patient’s
own cartilage cells into the damaged area.
See HCPCS Level II code J7330 (autologous cultured chondrocyte implant) for the actual supply
of cultured chondrocytes.
Sourcse: 2002 CPT Changes: An Insider’s View, AMA; December 2003 CPT Assistant
newsletter, AMA.