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The procedure described by CPT® Code 29892 involves an arthroscopically aided repair of significant osteochondritis dissecans lesions, talar dome fractures, or tibial plafond fractures. Osteochondritis dissecans is a condition characterized by the separation of a fragment of bone along with the overlying cartilage from the underlying bone, often occurring in the ankle joint. This separation can lead to the formation of loose bodies within the joint or result in cracks in the bone without complete detachment. The talar dome refers to the rounded upper surface of the talus bone, which articulates with the tibia and fibula, while the tibial plafond, also known as the tibial pilon, is the weight-bearing surface at the distal end of the tibia. The procedure is performed using arthroscopy, a minimally invasive surgical technique that allows for direct visualization of the joint through small incisions. The leg is positioned to facilitate access to the ankle joint, and the procedure may involve the use of internal fixation methods, such as wires, pins, or screws, to stabilize the affected area. Additionally, bone grafting may be necessary depending on the extent of the lesion or fracture, ensuring proper healing and restoration of joint function.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 29892 is indicated for the following conditions:
The procedure begins with the positioning of the leg on an L-shaped bar, ensuring that the thigh is supported while the knee is bent, allowing the lower leg to swing freely. The foot is secured in a bracelet, and distraction of the ankle joint is performed. A needle is then inserted into the joint at the anteromedial aspect, followed by inflation of the joint with saline to create a working space. After withdrawing the needle, an anteromedial portal is established. A trocar is introduced through this portal, allowing the insertion of the arthroscope for direct visualization of the joint. The surgeon inspects the joint for any signs of injury, disease, or infection, locating the dissecans lesion or fracture within the talus or tibia. An anterolateral portal is subsequently created to facilitate access to the affected area. The procedure involves the removal of any bone fragments and debridement of the damaged bone and cartilage. To promote healing, subchondral drilling of the tibia or talus may be performed, stimulating blood flow to the lesion or fracture site. Depending on the size of the dissecans lesion or the severity of the fracture, additional procedures such as bone grafting may be necessary. Internal fixation techniques, including the use of wires, pins, or screws, may also be employed to secure the dissecans lesion or fracture fragments. In cases where medial dome lesions or fractures are present, drilling through the medial malleolus may be required, or the joint may need to be opened to complete the procedure. After addressing the injury, the joint is thoroughly flushed with saline to remove any debris. Finally, the arthroscope and surgical instruments are removed, and the incisions made for the portal and arthrotomy are closed.
Post-procedure care typically involves monitoring for any signs of complications, such as infection or excessive swelling. Patients may be advised to follow specific rehabilitation protocols to restore mobility and strength in the ankle joint. The recovery process may vary depending on the extent of the procedure and the individual patient's condition. Follow-up appointments are essential to assess healing and determine the appropriate timeline for resuming normal activities.
| Short Descr | ANKLE ARTHROSCOPY/SURGERY | Medium Descr | ARTHRS AID RPR LES/TALAR DOME FX/TIBL PLAFOND FX | Long Descr | Arthroscopically aided repair of large osteochondritis dissecans lesion, talar dome fracture, or tibial plafond fracture, with or without internal 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) | 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 | 162 - Other OR therapeutic procedures on joints |
| 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. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | 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). | 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) | SG | Ambulatory surgical center (asc) facility service | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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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| 1998-01-01 | Added | First appearance in code book in 1998. |
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