july 2010

Meniscal Transplantation

When a patient has arthritis that has destroyed the articular surface of the knee joint, it may be necessary to perform a total knee arthroplasty with a joint prosthesis. However, there are times when someone can have a severe meniscal injury, where a majority of the meniscus needs to be removed but the overall integrity of the cartilage on the joint surface is maintained. If the patient goes on to have continued pain, a meniscal allograft transplantation can be performed. The procedure starts by arthroscopically removing any remaining portions of the meniscus. Holes may be drilled into the tibia to use as anchoring points or portions of the articular surface can be taken down for passage of the donor meniscus. The cartilage can also be roughened up to create a bleeding surface to aide in the healing process. Each physician will have their own preference when it comes to preparation of the joint space and fixation techniques. Once joint preparation has been completed an incision is made, dissection is taken down to the joint with an arthrotomy on either the medial or lateral side of the knee depending on which meniscus is being replaced. When an arthroscopy is initiated and followed by an open procedure we are accustomed to only reporting the open procedure, but when you look at the CPT code description for this “arthroscopic” procedure it includes an arthrotomy for insertion of a donor meniscus, so for the purposes of coding this remains an arthroscopic procedure. (Note: There isn’t a CPT code for an open meniscal transplantation procedure.) Once the meniscus has been inserted and positioned within the joint space it is sutured into place using arthroscopic visualization with the anterior and posterior horns attached to the tibia usually through the arthrotomy. The scope is then removed and the incisions are closed.

This service is reported as 29868 – Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateral

You would not report 29874, 29877, 29881 or 29882 if these procedures are performed in the same compartment as the meniscal transplantation.