29883

Arthroscopy, knee, surgical; with meniscus repair (medial AND lateral)

CPT code 29883 represents a surgical arthroscopy of the knee that includes the repair of both the medial and lateral menisci within the same knee joint. The menisci are C-shaped pieces of fibrocartilage that act as shock absorbers and provide stability between the femur and tibia. When a patient sustains complex trauma, such as a severe twisting injury, both menisci can be torn simultaneously. This leads to profound knee pain, significant effusion, mechanical catching, instability, or a 'locked' knee joint where full extension or flexion is physically blocked by the displaced meniscal tissue. The procedure begins with the patient under general or regional anesthesia. The affected lower extremity is prepped and draped in a sterile fashion, and a pneumatic tourniquet is typically applied to the proximal thigh to ensure a bloodless and clearly visible surgical field. The surgeon establishes standard arthroscopic portals, usually beginning with the anterolateral and anteromedial portals. An arthroscope connected to a high-definition video monitor is inserted to perform a comprehensive diagnostic tour of the entire knee joint. The surgeon meticulously assesses the articular cartilage, anterior and posterior cruciate ligaments, and both meniscal compartments. Upon definitively identifying repairable tears in both the medial and lateral menisci, the surgeon prepares the torn edges. Using an arthroscopic shaver, rasp, or trephine, the synovial edges and the tear interfaces are debrided and abraded to stimulate bleeding and promote a robust biological healing response. The surgeon then proceeds to repair the first meniscus, utilizing an all-inside, inside-out, or outside-in suturing technique depending on the specific tear pattern and location. Specialized meniscal repair devices or suture anchors are passed across the tear to coapt the edges securely. This precise process is then repeated for the second meniscus in the opposite compartment. Throughout the lateral repair, the surgeon exercises extreme caution to protect adjacent neurovascular structures, particularly the common peroneal nerve. Once both menisci are adequately repaired, the surgeon uses an arthroscopic probe to confirm stability, proper coaptation, and appropriate tension of the repairs. The knee joint is then copiously irrigated to clear out any remaining surgical debris or loose bodies. The arthroscopic instruments are withdrawn, and the portal incisions are carefully closed using non-absorbable sutures or surgical adhesive strips. A sterile compressive dressing and a hinged knee brace are typically applied to protect the bilateral repairs during the critical early postoperative rehabilitation phase.

Clinical Indications

  • Acute, traumatic tears involving both the medial and lateral menisci of the same knee.
  • Bucket-handle tears of both menisci causing mechanical locking or severe catching of the knee joint.
  • Symptomatic bilateral meniscal tears localized to the vascularized (red-red or red-white) zones suitable for repair.
  • Persistent knee pain, joint effusion, and instability confirmed by MRI to be caused by tears in both meniscal compartments.
  • Concomitant medial and lateral meniscal tears encountered during an anterior cruciate ligament (ACL) reconstruction.

Procedure Steps

  1. Position the patient supine on the operating table, administer appropriate anesthesia, and apply a proximal thigh tourniquet.
  2. Prep and drape the affected lower extremity in a standard sterile surgical fashion.
  3. Create standard arthroscopic portals (anterolateral and anteromedial) to access the knee joint.
  4. Insert the arthroscope and perform a complete diagnostic evaluation of the knee compartments.
  5. Identify and probe the tears in both the medial and lateral menisci to confirm they are repairable.
  6. Use an arthroscopic shaver or meniscal rasp to abrade the edges of both tears to stimulate a bleeding healing response.
  7. Perform the repair of the medial meniscus using an inside-out, outside-in, or all-inside suturing technique.
  8. Perform the repair of the lateral meniscus using an appropriate suturing technique, taking care to avoid neurovascular damage.
  9. Probe both repaired menisci to ensure stable fixation and adequate anatomical reduction of the meniscal tissue.
  10. Irrigate the knee joint copiously to remove debris, drain the fluid, remove the instruments, and close the portal sites.
  11. Apply a sterile dressing and fit the patient with a protective postoperative knee brace.

Coding Guidelines

  • CPT 29883 includes the repair of both the medial AND lateral menisci in the same knee. Do not report this code if only one meniscus is repaired; use 29882 instead.
  • Diagnostic knee arthroscopy (CPT 29870) is included in the surgical arthroscopy and should not be reported separately.
  • Synovectomy (29875 or 29876) is generally considered bundled if performed in the same compartment(s) as the meniscal repair, unless performed in a separate, distinct compartment for a separate pathology.
  • Do not append Modifier 50 (Bilateral Procedure) for repairing both menisci in the same knee, as the code description inherently covers both compartments of one knee. Modifier 50 is only appropriate if 29883 is performed on both the left and right knees.
  • If a meniscectomy is performed on one meniscus and a repair on the other, you must follow NCCI edits, which may require specific modifiers if billing meniscectomy codes (29880/29881) alongside repair codes, though typically the comprehensive code takes precedence.
  • Meniscal repair devices and implants may be reported separately to certain payers using appropriate HCPCS Level II codes (e.g., L8699), but check individual payer policies.

Associated ICD-10 Codes