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The CPT® Code 29850 refers to the arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, which may occur with or without manipulation and does not involve internal or external fixation. This procedure is particularly relevant for treating fractures that typically affect children, often referred to as tibial eminence fractures. The intercondylar spines are anatomical structures located at the center of the proximal tibia, situated between the lateral and medial condyles, and play a crucial role in knee stability. The tibial tuberosity, on the other hand, is a prominent bony projection on the anterior aspect of the proximal tibia, serving as the attachment point for the patellar ligament. During the procedure, the physician makes portal incisions over the anterior knee joint, specifically at the medial and lateral sides, to access the joint space. An arthroscope, which is a specialized instrument equipped with a camera, along with a cannula, is introduced to visualize the knee joint. This allows for the evacuation of any blood or fluid present in the joint, facilitating a clear view of the fracture. Once the fracture is identified, a small incision is made near the tibial tubercle to facilitate the repair process. Guide pins are strategically placed on either side of the anterior cruciate ligament and passed through the intercondylar fracture fragment to aid in stabilization. The procedure involves the use of a cannulated suture passer, which is inserted to place suture material that is then drawn out of the joint. By applying tension to the sutures, the physician can effectively reduce the fracture fragments, which are subsequently secured by tying the sutures over a bony bridge. This method ensures that the fracture fragments are held in place during the healing process. In contrast, the related procedure coded as 29851 involves the use of internal or external fixation methods, such as K-wires or screws, to stabilize the fracture fragments, which may also be applied in the case of tuberosity fractures. Overall, CPT® Code 29850 encompasses a minimally invasive approach to treating specific knee fractures, emphasizing the importance of arthroscopic techniques in orthopedic surgery.
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The procedure associated with CPT® Code 29850 is indicated for the treatment of specific knee fractures, particularly:
The procedure for CPT® Code 29850 involves several key steps to ensure effective treatment of the knee fractures:
After the completion of the procedure coded as CPT® 29850, the patient may require specific post-operative care to ensure proper recovery. This typically includes monitoring for any signs of complications, such as infection or excessive swelling. The physician may provide instructions regarding weight-bearing activities, physical therapy, and pain management strategies. Follow-up appointments are essential to assess the healing process and to determine when the patient can safely resume normal activities. The overall recovery time may vary depending on the severity of the fracture and the individual patient's healing response.
| Short Descr | KNEE ARTHROSCOPY/SURGERY | Medium Descr | ARTHROSCOPY AID TX SPINE&/FX KNEE W/O FIXJ | Long Descr | Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation; without internal or external fixation (includes arthroscopy) | 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) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | 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 | 147 - Treatment, fracture or dislocation of lower extremity (other than hip or femur) |
| 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. | 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.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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 |
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| 1993-01-01 | Added | First appearance in code book in 1993. |
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