Billing and Coding: Arthroscopic Lavage and Arthroscopic Debridement for the
Osteoarthritic Knee  Medical Policy Article

_Arthroscopy is a surgical procedure that allows the direct visualization of
the interior joint space. In addition to providing visualization, arthroscopy
enables the process of joint cleansing through the use of lavage or
irrigation. Lavage alone may involve either large or small volume saline
irrigation of the knee by arthroscopy. Although generally performed to reduce
pain and improve function, current practice does not recognize the benefit of
lavage alone for the reduction of mechanical symptoms. Arthroscopy also
permits the removal of any loose bodies from the interior joint space, a
procedure termed debridement._ (CMS Publication 100-03, _Medicare National
Coverage Determinations Manual_ , Chapter 1, Part 2, Section 150.9).  
  
In June, 2004 CMS issued a national coverage determination (NCD) for non-
covered arthroscopic procedures for patients with osteoarthritis. This NCD
specified that medical necessity decisions for coverage of debridement
procedures in patients without severe osteoarthritis of the knee who presented
with symptoms in addition to pain were at the discretion of the Medicare
contractor (carrier or intermediary). This article reiterates non-coverage
instructions in CMS Publication 100-03, _Medicare National Coverage
Determinations Manual_ , Chapter 1, Part 2, Section 150.9 and provides coding
and billing guidelines for arthroscopic lavage and debridement procedures. All
language quoted from Centers for Medicare and Medicaid Services (CMS) National
Coverage Determinations (NCDs) and coverage provisions in interpretive manuals
are italicized throughout this article.  
  
_**Indications:**_  
  
Not applicable  
  
 _ _**Limitation:**  
  
CMS does not consider the following procedures to be reasonable or necessary
in the treatment of the osteoarthritic knee and is considered non-covered by
the Medicare program:  
  
__

  * Arthroscopic lavage used alone for the osteoarthritic knee; or 
  * Arthroscopic debridement for osteoarthritic patients presenting with knee pain only; or, 
  * Arthroscopic debridement and lavage with or without debridement for patients presenting with severe osteoarthritis

__Patients without severe osteoarthritis of the knee who present with symptoms
other than pain alone; i.e., (1) mechanical symptoms that include, but are not
limited to, locking, snapping, or popping (2) limb and knee joint alignment,
and (3) less severe and/or early degenerative arthritis, remain at local
contractor discretion. Medicare contractors may require submission of one or
all of the following documents to define the patient 's knee condition:  
__

  * Operative notes, 
  * Reports of standing x-rays, or, 
  * Arthroscopy results.

**Coding Information:**  
  
Procedure codes may be subject to National Correct Coding Initiative (NCCI)
edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to
billing Medicare.  
  
For services requiring a referring/ordering physician, the name and NPI of the
referring/ordering physician must be reported on the claim.  
  
A claim submitted without a valid ICD-10-CM diagnosis code will be returned to
the provider as an incomplete claim under Section 1833(e) of the Social
Security Act.  
  
The diagnosis code(s) must best describe the patient's condition for which the
service was performed.  
  
_Advance Beneficiary Notice of Noncoverage (ABN) Modifier Guidelines (for
outpatient services):_  
  
An ABN may be used for services which are likely to be non-covered, whether
for medical necessity or for other reasons. Refer to CMS Publication 100-04,
_Medicare Claims Processing Manual_ , Chapter 30, revised 09/05/2008, for
complete instructions.  
  
 **Specific coding information for this policy**  
  
The physician/provider performing the procedure is responsible for identifying
those patients for whom Medicare does not consider the procedure "reasonable
or necessary."  
  
Report CPT code 29999 (Unlisted procedure, arthroscopy) for arthroscopic
lavage of the knee for treatment of osteoarthritis and/or arthroscopic
debridement and lavage for patients with severe osteoarthritis.  
  
Report CPT code 29877 (Arthroscopy, knee, surgical; debridement/shaving of
articular cartilage [chrondroplasty]) for arthroscopic debridement with
presentation of knee pain only, or arthroscopic debridement without lavage for
patients with severe osteoarthritis.  
  
Report HCPCS code G0289 for arthroscopy, knee, surgical, for removal of loose
body, foreign body, debridement/shaving of articular cartilage (chondroplasty)
at the time of other surgical knee arthroscopy in a different compartment of
the same knee.  
  
 **For claims submitted to the Part B MAC:**  
  
All services/procedures performed on the same day for the same beneficiary by
the physician/provider should be billed on the same claim.