CPT® Code 29885

Official Description

Arthroscopy, knee, surgical; drilling for osteochondritis dissecans with bone grafting, with or without internal fixation (including debridement of base of lesion)

Common Language Description

Arthroscopy of the knee is a minimally invasive surgical procedure that allows for the examination and treatment of various knee joint conditions. In the context of CPT® Code 29885, the procedure specifically addresses osteochondritis dissecans, a condition characterized by the separation of a bone fragment and the overlying cartilage from the underlying bone, often leading to joint pain and dysfunction. This condition can result in loose bodies within the knee joint or cracks in the bone without complete detachment of the fragment. The procedure involves making small incisions, known as portal incisions, on the medial and lateral sides of the knee joint to facilitate access. An arthroscope, a specialized instrument equipped with a camera, is introduced through one of these portals to visualize the internal structures of the knee. A cannula is then inserted through a second portal to allow for the flushing of the joint with saline solution, which helps in cleaning the area and providing a clear view for examination. During the procedure, the surgeon locates the dissecans fragment and may perform debridement of the base of the lesion to remove any damaged tissue. The next step involves drilling small holes through the articular cartilage and into the underlying bone, creating channels that promote blood vessel infiltration and the regeneration of healthy tissue. In cases where the osteochondritis dissecans lesion is extensive or chronic, bone grafting may be necessary, with grafts typically harvested from the proximal tibia and packed into the drilled holes. Additionally, internal fixation may be employed to stabilize the dissecans fragment, either in conjunction with or independently of bone grafting. The procedure concludes with the removal of the arthroscope and instruments, followed by the closure of the portal incisions.

1. Indications

The procedure described by CPT® Code 29885 is indicated for the treatment of osteochondritis dissecans in the knee. This condition may present with the following symptoms or conditions:

Joint Pain: Patients may experience pain in the knee joint, particularly during movement or weight-bearing activities.
Swelling: Inflammation and swelling around the knee joint may occur due to the presence of loose bodies or irritation from the dissecans lesion.
Joint Instability: The detachment of bone and cartilage can lead to a feeling of instability or giving way in the knee.
Limited Range of Motion: Patients may have difficulty fully extending or flexing the knee due to pain or mechanical blockage from loose fragments.

2. Procedure

The procedure for CPT® Code 29885 involves several critical steps to effectively address osteochondritis dissecans:

Step 1: Portal Incision Creation - The surgeon begins by making small incisions on the medial and lateral aspects of the knee joint. These incisions serve as access points for the arthroscope and other surgical instruments.
Step 2: Arthroscope Introduction - An arthroscope, which is a thin tube with a camera, is inserted through one of the portal incisions. This allows the surgeon to visualize the internal structures of the knee joint on a monitor.
Step 3: Joint Flushing - A cannula is introduced through the second portal, and the knee joint is flushed with saline solution. This step helps to clear debris and provides a better view of the joint's condition.
Step 4: Examination of the Joint - The surgeon examines the knee for any signs of disease, injury, or infection, specifically looking for the dissecans fragment.
Step 5: Debridement of the Lesion - If necessary, the base of the lesion is debrided to remove any damaged or necrotic tissue, preparing the area for further treatment.
Step 6: Drilling - Multiple small drill holes are created through the articular cartilage and into the underlying bone. This drilling process forms tunnels that facilitate the infiltration of blood vessels, promoting healing and the replacement of dead bone with living tissue.
Step 7: Bone Grafting (if necessary) - In cases where the osteochondritis dissecans lesion is large or chronic, bone grafts may be harvested from the proximal tibia and packed into the drilled holes to support healing.
Step 8: Internal Fixation (if necessary) - Internal fixation may be applied to compress and stabilize the dissecans fragment, either in conjunction with or independently of the bone grafting.
Step 9: Final Inspection and Closure - The knee is flushed again with saline solution to remove any remaining debris, and the joint is re-inspected. Finally, the arthroscope, cannula, and other instruments are removed, and the portal incisions are closed.

3. Post-Procedure

After the completion of the procedure, patients may require specific post-operative care to ensure proper healing and recovery. This may include rest, ice application to reduce swelling, and elevation of the knee. Patients are typically advised to follow a rehabilitation program that may involve physical therapy to restore strength and range of motion. The duration of recovery can vary based on the extent of the procedure and the individual patient's condition. Follow-up appointments are essential to monitor healing and assess the knee's function. Any signs of complications, such as increased pain, swelling, or infection, should be reported to the healthcare provider promptly.

Short Descr	KNEE ARTHROSCOPY/SURGERY
Medium Descr	ARTHRS KNEE DRILL OSTEOCHONDRITIS DISSECANS GRFG
Long Descr	Arthroscopy, knee, surgical; drilling for osteochondritis dissecans with bone grafting, with or without internal fixation (including debridement of base of lesion)
Status Code	Active Code
Global Days	090 - Major Surgery
	Preoperative
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	3 - Special payment adjustment rules for multiple endoscopic 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.
Endoscopic Base Code	29870 Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator	Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate.
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	P8A - Endoscopy - arthroscopy
MUE	1
CCS Clinical Classification	162 - Other OR therapeutic procedures on joints

	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.
	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.)
	Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
	Left side (used to identify procedures performed on the left side of the body)
	Right side (used to identify procedures performed on the right side of the body)
	Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service