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The CPT® Code 29851 refers to the arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, which may be performed with or without manipulation. This procedure is particularly relevant for pediatric patients, as these types of fractures are more commonly seen in children and are often referred to as tibial eminence fractures. The intercondylar spines are two bony projections located centrally on the proximal surface of the tibia, situated between the lateral and medial condyles. 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. An arthroscope, along with a cannula, is then introduced to visualize the knee joint. This allows for the evacuation of any blood or fluid present in the joint space, facilitating a clear view of the fracture. Once the fracture is identified, a small incision is made just medial to the tibial tubercle to access the fracture site. Guide pins are inserted on either side of the anterior cruciate ligament and passed through the intercondylar fracture fragment to aid in stabilization. The procedure may involve the use of a cannulated suture passer to place suture material, which is then used to reduce the fracture fragments by applying tension and securing them over a bony bridge. Alternatively, the fracture fragments may be stabilized using internal fixation methods, such as K-wires or screws, placed under arthroscopic guidance. In some cases, an external fixation device may also be utilized, either as a standalone solution or in conjunction with internal fixation techniques. Tuberosity fractures are treated similarly, employing either suture material or fixation devices to ensure proper alignment and healing of the fracture fragments.
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The procedure described by CPT® Code 29851 is indicated for the treatment of specific knee injuries, particularly:
The procedure for CPT® Code 29851 involves several key steps to ensure effective treatment of the knee fractures:
Post-procedure care following the treatment described by CPT® Code 29851 typically involves monitoring the patient for any complications and ensuring proper healing of the knee. Patients may be advised to follow specific rehabilitation protocols to restore function and strength to the knee joint. The physician will provide guidance on weight-bearing activities and may recommend physical therapy to aid in recovery. Follow-up appointments are essential to assess the healing process and to make any necessary adjustments to the treatment plan.
| Short Descr | KNEE ARTHROSCOPY/SURGERY | Medium Descr | ARTHROSCOPY AID TX SPINE&/FX KNEE W/FIXJ | Long Descr | Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation; with 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) | 2 - Payment restriction for assistants at surgery does not apply 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. | 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.) | 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) |
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| 1993-01-01 | Added | First appearance in code book in 1993. |
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