CPT® Code 29800

Official Description

Arthroscopy, temporomandibular joint, diagnostic, with or without synovial biopsy (separate procedure)

Common Language Description

An arthroscopy of the temporomandibular joint (TMJ) is a minimally invasive surgical procedure that allows for the examination and potential treatment of disorders affecting the TMJ. This joint, which connects the jawbone to the skull, can be subject to various structural issues that may lead to pain, dysfunction, or other symptoms. The procedure is performed using small incisions and specialized instruments, including an arthroscope, which is a thin tube equipped with a camera that provides visual access to the joint. The common language description outlines the process of marking entry points for the procedure, which are based on anatomical landmarks such as the posterior border of the tragus of the ear and the lateral canthus of the eye. The procedure begins with the insertion of a needle to access the joint space, followed by the introduction of a trocar and cannula to facilitate the insertion of the arthroscope. During the diagnostic phase, the TMJ is carefully examined for signs of injury or disease, including conditions like fibrous adhesions, floating debris, or disc displacement. If necessary, synovial tissue samples may be collected for laboratory analysis to further assess the joint's condition. This procedure is classified as a separate procedure, meaning it is performed independently and may not be bundled with other surgical interventions unless specified. The diagnostic nature of CPT® Code 29800 emphasizes its role in identifying issues within the TMJ, which can inform subsequent treatment options.

1. Indications

The indications for performing an arthroscopy of the temporomandibular joint (TMJ) include the following:

Joint Pain Persistent pain in the TMJ that may indicate underlying structural issues.
Joint Dysfunction Difficulty in jaw movement or function, which may suggest mechanical problems within the joint.
Disc Displacement Evidence of displacement of the articular disc, which can lead to clicking or locking of the jaw.
Fibrous Adhesions Presence of fibrous tissue that may restrict movement and cause discomfort.
Floating Debris Identification of loose bodies within the joint space that may contribute to pain or dysfunction.

2. Procedure

The procedure for performing a diagnostic arthroscopy of the TMJ involves several key steps:

Step 1: Marking Entry Points The surgeon begins by marking two entry points on the skin, using the posterior border of the tragus of the ear and the lateral canthus of the eye as anatomical reference points. This ensures accurate placement for accessing the joint.
Step 2: Needle Insertion A needle is then inserted at the anterior entry point, and the surgeon advances it until it makes contact with the zygomatic bone. This step is crucial for establishing access to the superior joint space.
Step 3: Trocar Insertion Following the needle insertion, the trocar contained within a cannula is introduced at the posterior entry point. The trocar is directed using an inferolateral approach toward the glenoid fossa, which is the socket of the joint.
Step 4: Joint Capsule Puncture The joint capsule is punctured to allow access to the joint space. This step is essential for the subsequent introduction of the arthroscope.
Step 5: Arthroscope Introduction After withdrawing the trocar, the arthroscope is introduced through the cannula. This instrument provides visual access to the TMJ, allowing the surgeon to perform a thorough examination.
Step 6: Diagnostic Examination The TMJ is examined for signs of injury or disease, including the presence of fibrous adhesions, floating debris, or disc displacement. This diagnostic phase is critical for determining the appropriate course of treatment.
Step 7: Synovial Biopsy (if needed) If indicated, synovial tissue samples may be obtained during the procedure for laboratory analysis, aiding in the diagnosis of any underlying conditions.

3. Post-Procedure

After the completion of the arthroscopy, the surgeon will remove the arthroscope and any surgical instruments used during the procedure. The incisions made for the entry points are then closed, typically with sutures or adhesive strips. Post-procedure care may include monitoring for any signs of complications, managing pain with prescribed medications, and providing instructions for activity restrictions during the recovery period. Patients are often advised to follow up with their healthcare provider to discuss the findings from the procedure and any further treatment options that may be necessary based on the diagnostic results.

Short Descr	JAW ARTHROSCOPY/SURGERY
Medium Descr	ARTHRS TEMPOROMANDIBULR JT DX W/WO SYNVAL BX SPX
Long Descr	Arthroscopy, temporomandibular joint, diagnostic, with or without synovial biopsy (separate procedure)
Status Code	Active Code
Global Days	090 - Major Surgery
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	1 - 150% payment adjustment for bilateral procedures applies.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator	Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	P8A - Endoscopy - arthroscopy
MUE	1
CCS Clinical Classification	149 - Arthroscopy

50	Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
51	Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
AS	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
GC	This service has been performed in part by a resident under the direction of a teaching physician
LT	Left side (used to identify procedures performed on the left side of the body)
RT	Right side (used to identify procedures performed on the right side of the body)
XU	Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service