Documenting Meniscectomy Procedure – Know the Medical Codes

Documenting Meniscectomy Procedure – Know the Medical Codes Meniscectomy is the surgical removal of all or part of a torn meniscus.

The article discusses the procedure in detail along with the ICD-10 and CPT codes.

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Meniscectomy is a surgery to repair meniscus or remove all or part of a torn meniscus. A meniscus (also called menisci) is a C-shaped band of cartilage (between the femur and the tibia) in your knee that acts as a shock absorber or cushion between the knee’s bones and helps to lubricate the knee joint.

There is one on the medial side (side closest to the midline of the body) and one on the lateral side of each knee. Typically, this type of knee injury is quite common among athletes or active individuals who normally get engaged in contact sports like football and hockey. People can also get this injury when they kneel, squat, or lift something heavy. Younger athletes often suffer more significant injuries than older adults. The risk of injury increases as people get older, when bones and tissues around the knee begin to gradually wear down or degenerate over time. A torn meniscus may not heal on its own as there is a limited blood supply to that area. Common symptoms include – chronic pain, swelling and limited knee function. The pain can be made worse by twisting or squatting motions. Orthopedic surgeons conducting meniscectomy should correctly document the procedure in the patients’ medical records. Outsourcing medical billing and coding tasks to a reliable medical billing and coding company can help physicians simplify their documentation process.

Reports suggests that repair of torn meniscus cartilage is one of the most common knee surgeries performed on people above 65 years. It is estimated that about 750,000 such procedures are performed each year (2016 statistics) in the United States, which account to nearly two-thirds of orthopedic knee arthroscopy procedures in older patients in 2016.A tear can occur in one or more directions in the meniscus. Traumatic tears (caused due to traumatic injury, often seen in athletes) are usually vertical whereas degenerative tears (visible in older patients who have more brittle cartilage) are usually horizontal. The specific pattern of the tear may directly determine whether a tear can be repaired or not. Generally, horizontal and flap tears require surgical removal of at least part of the meniscus.

Why Is Meniscectomy Done?

If a meniscus tear is causing pain or swelling, it possibly means that torn pieces of the meniscus need to be removed and the edges surgically shaved to make the remaining meniscus smooth. The final decision regarding the procedure will be based on several factors like – how strong the meniscus is,

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where the tear is, and how big the tear is. Consulting physicians or orthopedic surgeons may recommend having the procedure if you have –    

A small tear at the outer edge of the meniscus (which doctors call the red zone) A moderate to large tear at the outer edge of the meniscus (red zone) A tear that spreads from the red zone into the inner two-thirds of the meniscus (called the white zone) A tear in the white zone of the meniscus, (repair surgery usually isn't done, because the meniscus may not heal)

The final decision to remove all or part of your meniscus will be done after taking into consideration the location, length, tear pattern, and stability of the tear as well as the condition of the whole meniscus. In addition, the condition of the knee, patient age and any age or injury-related degeneration will also be considered.

As with any surgical procedures, meniscectomy also carries its own set of risk elements or complications like –pain, infection, bleeding, nerve damage, blood clots, further tear and knee stiffness after surgery.

Preparing for Meniscectomy – What the Procedure Involves Meniscectomy involve two types – partial and total meniscectomy. In the first type, the surgeon will remove only a piece of the torn meniscus so that your knee can function normally. However, for the second procedure the surgeon will remove the whole meniscus. The decision about the choice of the surgery will be made after considering several related factors such as the size, location and pattern of the meniscus tear as well as the general health, past medical history, age, physical activity level and personal preferences of the patient. Generally, orthopedic surgeons most often perform arthroscopic (minimally invasive) technique (a procedure used to both examine and repair the inside of a joint), since they most often lead to more rapid and complete recovery.

The arthroscopic procedure is generally performed under general or local anesthesia. The surgeon will make tiny incisions (cuts)(about 1 centimeter) in your knee and access the meniscus using special surgical tools like arthroscope and a tiny camera. Surgeons will use the arthroscope and other small tools to examine and analyze the extent of damage, clean out the area, repair tears (if any) and fix your meniscus. The surgeon may repair www.outsourcestrategies.com

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your meniscus with stitches or a device. He/she may remove all or part of your meniscus and may transplant a piece of donor meniscus into your knee to replace what has been removed. In addition, your surgeon may also fix other damage to bones, ligaments, tendons, or tissue during your surgery.

As a final step, the incision will be closed with stitches, adhesive tape, or bandages.

Orthopedics medical billing and coding can be complex. Orthopedic surgeons performing various arthroscopic procedures must use the relevant diagnosis and procedure codes to bill the procedure correctly. The following codes are used for medical billing purposes – ICD-10 Codes S83.2 - Tear of meniscus, current injury         

S83.20 S83.21 S83.22 S83.23 S83.24 S83.25 S83.26 S83.27 S83.28

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Tear of unspecified meniscus, current injury Bucket-handle tear of medial meniscus, current injury Peripheral tear of medial meniscus, current injury Complex tear of medial meniscus, current injury Other tear of medial meniscus, current injury Bucket-handle tear of lateral meniscus, current injury Peripheral tear of lateral meniscus, current injury Complex tear of lateral meniscus, current injury Other tear of lateral meniscus, current injury

CPT Codes    

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27332 - Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee 27333 - Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee 29868 - Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateral 29880 - Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed 29881 - Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving

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 

of articular cartilage (chondroplasty), same or separate compartment(s), when performed 29882 - Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral) 29883 - Arthroscopy, knee, surgical; with meniscus repair (medial AND lateral)

HCPCS Code 

G0428 - Collagen meniscus implant procedure for filling meniscal defects (e.g., CMI, collagen scaffold, Menaflex)

What Happens after the Procedure?

Once the procedure is complete, patients will be shifted to a recovery room a (until they are fully awake) wherein they will be closely monitored.

Generally, only minimal pain is associated with arthroscopic knee surgery.

Following the procedure, patients will be given clear instructions on what type of pain medicines to consume(if they experience discomfort). Keeping the knee elevated and icing the knee is helpful for the first few days after surgery.

When patient condition improves, they will be taken to a separate hospital room and specific instructions on speedy recovery will be given which include–  

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Patients should try to walk around (soon after 2-3 days of surgery) as small movements will help prevent blood clots.

Patients may need to use a continuous passive motion (CPM) machine right after the surgery. Your leg may be put into a CPM machine and the machine moves the leg back and forth very slowly without having to use or strain muscles. This movement can reduce pain and swelling, and help the knee heal faster.

Patients may need to wear pressure stockings or inflatable boots after surgery. These stockings are tight and put pressure on your legs.

Inflatable boots on the other hand, have an air pump that tightens and loosens different areas of the boots. Both of these improve blood flow and prevent clots.

Before leaving the hospital, a physiotherapist will visit the patients and explain to them about gentle exercises that will help movement and strength, restore range of motion and decrease pain.

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In addition, pain medications and antibiotics will be prescribed to help reduce pain and prevent bacterial infections.

The time of recovery after the surgery varies depending on the injury, the type of surgical procedure performed, the orthopedic surgeon’s preferences along with patient age, health status and activities. Meniscus surgery is usually followed by a period of rest, walking, and selected exercises. Most people who have arthroscopic meniscectomy can bear weight a day or two after surgery and return to full activity within 4 to 6 weeks. Patients need to wear a brace to keep their knee stable. In some cases, they also have to use crutches for at least a month to keep weight off your knee.

Medical billing and coding for torn meniscus repair can be complex. With all the challenges involved, the best option for orthopedic physicians is to rely on specialized medical billing and coding services for timely and accurate claim submission. Experienced team members in an established outsourcing company can handle all the billing and coding challenges competently and help healthcare providers maximize revenue cycle and improve patient care.

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