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An arthroscopy of the temporomandibular joint (TMJ) is a minimally invasive surgical procedure that allows for both diagnosis and treatment of various structural disorders affecting the joint. The TMJ is a complex joint that connects the jawbone to the skull, and it can be affected by conditions such as disc displacement, fibrous adhesions, and other injuries or diseases. During the procedure, two specific entry points are identified based on anatomical landmarks: the posterior border of the tragus of the ear and the lateral canthus of the eye. This precise localization is crucial for accessing the joint effectively. A needle is first used to puncture the skin at the anterior entry point, allowing the surgeon to reach the zygomatic bone, which serves as a guide for further access into the superior joint space. Following this, a trocar within a cannula is inserted at the posterior entry point using an inferolateral approach directed toward the glenoid fossa, where the joint capsule is punctured. This technique enables the introduction of an arthroscope, which is a specialized instrument equipped with a camera, allowing for visualization of the TMJ. The procedure may include diagnostic elements, such as examining the joint for signs of injury or disease, and may also involve therapeutic interventions, such as the lysis of fibrous adhesions, which is a common treatment for persistent anterior disc displacement. The use of additional portals may facilitate the introduction of surgical instruments to enhance the treatment process. Ultimately, the arthroscope and any surgical tools are removed, and the incisions are closed, marking the completion of the procedure.
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The arthroscopy of the temporomandibular joint (TMJ) is indicated for various conditions that affect the function and structure of the joint. The following are explicitly provided indications for this procedure:
The procedure for arthroscopy of the temporomandibular joint involves several key steps, each critical for ensuring a successful outcome. The following procedural steps are outlined:
After the arthroscopy of the temporomandibular joint, patients may experience a recovery period that varies based on the extent of the procedure performed. Post-procedure care typically includes monitoring for any signs of complications, managing pain, and following specific instructions for activity restrictions. Patients may be advised to apply ice to the affected area to reduce swelling and discomfort. Follow-up appointments are essential to assess healing and the effectiveness of the procedure. Additionally, physical therapy may be recommended to restore function and mobility in the TMJ. It is important for patients to adhere to their healthcare provider's recommendations to ensure optimal recovery and outcomes.
| Short Descr | JAW ARTHROSCOPY/SURGERY | Medium Descr | ARTHROSCOPY TEMPOROMANDIBULAR JOINT SURGICAL | Long Descr | Arthroscopy, temporomandibular joint, surgical | 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) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | 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 |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GA | Waiver of liability statement issued as required by payer policy, individual case | 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) |
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| 1991-01-01 | Added | First appearance in code book in 1991. |
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