Ankle Scope....HELP!

melissabriar1

I have a surgeon who performed debridement/synovectomy (29898), removed 10mm loose body(29894), abrasion chondroplasty/excision of osteochondral lesion (29891) and a distal tibial exostectomy. The provider wants to bill 27640 for the distal tibial exostectomy, however, the procedure was done totally through the scope. Could an unlisted code be billed for the exostectomy or would it be included in the debridement and/or osteochondral lesion removal? I'm having a hard time finding any information that pertains to an arthroscopic exostectomy, but there is plenty of info out there about open exostectomy...
The exotosis was found on the "anterior edge of the distal tibia". The osteochondral lesion was found on the "lateral most aspect of the talar dome".

golymom

You are correct, he can't do it  as an open procedure when done through the scope.  I have always considered arthroscopic removal of exostoses/osteophytes as a debridement 29898.  Remember CCI says that debridement when done with any other arthroscopic procedure in the same joint is bundled.  It won't show up in the tables because we are told it in the chapter guidelines.  Reimbursement for the loose body will also be healthplan driven.  AAOS allows based upon size but seems to be difficult to get the healthplans to see it.