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Coding & Billing
When to Report Synovectomy Separately
G. John Verhovshek
Publish Date: September 4, 2008   |  Tags:   Financial Management

When reviewing synovectomy claims, look to the surgeon's documentation for evidence that the procedure occurred in a different knee compartment than other, same-session arthroscopic procedures. If so, you may be able to enhance reimbursement — depending on the surgeon's reason for clearing the synovium.

If the surgeon performs synovectomy (29875, Arthroscopy, knee, surgical; synovectomy, limited [e.g., plica or shelf resection]: APC 0041) in the same knee compartment in which he also performs, for example, single-compartment meniscectomy (29881, ??? with meniscectomy [medial OR lateral, including any meniscal shaving]: APC 0041), you'll report only the more extensive meniscectomy procedure.

CPT designates limited synovectomy code 29875 as a "separate procedure." "Codes with the ???separate procedure' designation normally would not be additionally reported when the procedure or service is performed as an integral component of another procedure or service," says the August 2001 CPT Assistant. In addition, the national Correct Coding Initiative (CCI) bundles 29875 to 29881, which further reinforces AMA guidelines that you wouldn't normally bill these codes together. Examples follow.

Which compartment?
As part of left lateral meniscectomy, the orthopedic surgeon performs arthroscopic synovectomy in the lateral compartment of the left knee. In this case, you'd report only 29881 because the meniscectomy includes synovectomy in the same knee compartment. If, however, the surgeon performs synovectomy independently of meniscectomy, you may claim the synovectomy. For example, if the surgeon performs a medial synovectomy and lateral meniscectomy, you should report 29875 separately, in addition to 29881 for the meniscectomy, because the synovectomy occurred in a different compartment.

When reporting 29875 separately, be sure to append modifier 59 (Distinct procedural service) to indicate to the payor that the synovectomy occurred at a separate location. AMA guidelines support this coding. CPT Assistant, August 2001, specifically states, "If the knee arthroscopy with limited synovectomy were performed in a different knee compartment than another knee procedure, modifier 59 would be appended to code 29875 to indicate that a different compartment was involved."

Note that the CCI also lets you append modifier 59 to unbundle 29875 from 29881 when the procedures occur in different areas.

The "major" synovectomy code
Be careful before stepping up to the "major" synovectomy code (29876, ??? synovectomy, major, two or more compartments [e.g., lateral or medial]: APC 0041) if the surgeon has documented meniscectomy on the same knee. You can easily, and wrongfully, charge separately for a synovectomy that isn't truly "separate." Note that code 29876 requires that the surgeon remove the synovium from two or more compartments (remember that the knee has three compartments: lateral, medial and patellofemoral).

Let's say the patient undergoes medial meniscectomy (29881), along with both medial and lateral synovectomies. You may be tempted to report a two-compartment synovectomy (29876) in this case. But, remember, the medial meniscectomy will include the medial synovectomy, so you can report only the limited code (29875) for the lateral synovectomy, according to AMA instructions.

Here's a source of confusion: The CCI doesn't bundle 29876 in the same way it bundles 29875, causing physicians and coders to believe, erroneously, that you can always report 29876 as long as the surgeon performs synovectomy in at least two compartments. This isn't true — the synovectomy must occur not just in two compartments, but in two "billable" compartments.

For example, consider a three-compartment synovectomy, with medial meniscectomy on the same knee. Here, we'd report the medial meniscectomy (29881), which includes the medial synovectomy. Because the lateral and patellofemoral synovectomies are distinct from the medial location, however, you could report 29876 separately for the two-compartment synovectomy — assuming there is a separate diagnosis to justify the procedure.

Bottom line
What matters is that the physician performs the synovectomy in two or more compartments in which he performs no other major work, such as a chondroplasty or meniscectomy.

Unfortunately, location alone doesn't define when you may report synovectomy separately from meniscectomy. Additionally, you should be sure that the surgeon cites a separate diagnosis for the synovectomy.

Surgeons frequently document three-compartment knee synovectomy. More often than not, they're clearing the synovium so that they can complete a diagnostic examination of the joint. In such a case, you're better off considering the synovectomy to be part of the surgical approach, rather than a therapeutic procedure.

Without a distinct diagnosis to support medical necessity for a separate synovectomy, payors will probably consider any synovectomy to be inclusive of same-session/same-knee meniscectomy.

Let's say the surgeon performs a plica resection (in the patellofemoral compartment) in addition to resection of the torn meniscus in a different joint. In this case, you would have a separate diagnosis of 727.83 (Calcium deposits in tendon and bursa) for the plica. As long as the surgeon performs no other procedures in the same compartment, you may report the resection separately.