29882

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

Arthroscopic meniscus repair, represented by CPT code 29882, is a specialized surgical procedure designed to preserve and fix a torn meniscus rather than removing it. The knee contains two menisci—medial and lateral—which are C-shaped pads of fibrocartilage that act as shock absorbers, stabilize the joint, and distribute weight between the femur and the tibia. Meniscal tears are common injuries often resulting from sudden twisting or degenerative changes. The decision to perform a repair (29882) as opposed to a meniscectomy (29881) is clinically significant because the meniscus is vital for long-term joint health; its removal significantly increases the risk of early-onset osteoarthritis. This procedure is specifically indicated for tears located in the vascular zones of the meniscus, where there is sufficient blood supply to facilitate healing. The surgical approach involves inserting an arthroscope and specialized instruments through small incisions. The surgeon evaluates the tear and uses various techniques, such as inside-out, outside-in, or all-inside suturing, to appose the torn edges. This repair process aims to restore the anatomical and functional integrity of the meniscus. Successful outcomes depend on the tear pattern, the age of the patient, the chronicity of the injury, and the patient's adherence to a strict postoperative rehabilitation protocol, which usually involves restricted weight-bearing and limited range of motion to protect the healing tissue.

Clinical Indications

  • Vertical longitudinal tears in the peripheral vascular zone (red-red or red-white zone)
  • Acute meniscus tears in pediatric and young adult populations
  • Bucket-handle meniscus tears that are reducible and stable
  • Meniscal instability causing mechanical symptoms like locking or catching
  • Concurrent ligamentous instability (e.g., ACL tear) where meniscal repair improves joint stability
  • Traumatic tears involving more than 1 cm of the meniscal body

Procedure Steps

  1. Administration of anesthesia and application of a thigh tourniquet.
  2. Creation of standard anterolateral and anteromedial portals for arthroscope and instrument access.
  3. Comprehensive diagnostic sweep of the knee joint to confirm the tear and check for other pathology.
  4. Preparation of the tear site by rasping or debriding the edges to create a bleeding bed for healing.
  5. Selection of repair technique: All-inside (using devices), Inside-out (using long needles and cannulas), or Outside-in (for anterior horn tears).
  6. Placement of high-strength sutures across the tear to compress the meniscus edges.
  7. Knot tying and tensioning to ensure a stable reduction of the tear.
  8. Probing the repaired meniscus to confirm stability and apposition.
  9. Lavage of the joint to remove any debris or blood.
  10. Closure of portal sites with sutures or adhesive strips and application of a compressive dressing.

Coding Guidelines

  • Code 29882 is used for a repair of the medial meniscus OR the lateral meniscus.
  • If repairs are performed on BOTH the medial and lateral menisci in the same knee, use code 29883.
  • Diagnostic arthroscopy (29870) is considered an inherent part of the surgical procedure and cannot be billed separately.
  • Surgical debridement (29877) in the same compartment as the repair is generally bundled and not separately reportable.
  • If a repair is performed on one meniscus and a partial meniscectomy is performed on the other meniscus of the same knee, use 29882 for the repair and 29881 for the meniscectomy (check NCCI edits for specific bundling and modifier requirements like -59 or -XS).
  • Modifier 50 should be used if a meniscus repair is performed on both the left and right knees during the same operative session.

Associated ICD-10 Codes