July 2017

Subchondroplasty

This month’s topic will be a subchondroplasty and we will start by reviewing the dictated portion of an op note along with the proper coding for this procedure.

“At this point, the knee was copiously irrigated prior to removing the arthroscopic instruments.  Attention was then turned to treatment of the insufficiency fracture.  On the back table, 5 cc of calcium phosphate were prepared and placed into five 1 cc syringes.  A small stab incision was made adjacent to the medial tibial plateau and a guidepin inserted into the area of insufficiency based on the AP and lateral fluoroscopic imaging.  1 cc at a time of the calcium phosphate was placed down the inner sleeve of our guidepin until the defect was filled in its entirety.  We took approximately 3 cc of calcium phosphate.  Once happy with the fill of our defect, the arthroscope was reinserted to ensure no extravasation and the joint was found to be clean.”

Although certain entities have advocated the use of CPT code 29855 – Arthroscopically aided treatment of tibial fracture, proximal – you can note in the dictation above that the arthroscope was removed prior to performing the subchondroplasty and then reinserted after the subchondroplasty to make sure none of the cement had leaked into the joint (extravasation). 

Since the calcium phosphate mixture was injected under fluoroscopic guidance and not performed as an arthroscopic procedure you should not report CPT code 29855.   See CPT Assistant article dated Jan. 2014 in which the AMA states that this service is reported with Unlisted CPT code 27599. 

 

 







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