Disposable Arthroscopy

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MP 7.01.06

Disposable Arthroscopy

Medical Policy
Section Surgery	Original Policy Date 12/1/95	Last Review Status/Date Reviewed by consensus/3:2003
Issue 3:2003		Return to Medical Policy Index

Disclaimer

Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract. Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage. Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.

Description

Arthroscopy is an invasive procedure that is performed to substantiate a diagnosis of intra-articular joint pathology, and to surgically treat such pathology.

Disposable arthroscopy (usually performed in an office setting) uses a small, flexible, disposable arthroscope that is 1.6–1.7mm in diameter. It operates with a fiberoptic system. The articular contents are viewed via video equipment and a television monitor.

This device is intended to permit arthroscopy, mostly for the knee, in an office setting under local anesthesia.

Policy

Disposable arthroscopy is considered investigational.

Policy Guidelines

No applicable information

Benefit Application

BlueCard/National Account Issues

Denial of this procedure or treatment is applicable for contracts or certificates of coverage that maintain an exclusion for investigational services.

Rationale

A search of literature was completed through the MEDLINE database for the period of January 1994 through January 1995. The search strategy focused on references containing the following Medical Subject Headings:

– Arthroscopy

– Office or Disposable

Research was limited to English-language journals on humans.

See also:

TEC Assessments 1994: Tab 6

Codes	Number	Description
CPT	29800	Arthroscopy, temporomandibular joint, diagnostic
	29805	Arthroscopy, shoulder, diagnostic
	29830	Arthroscopy, elbow, diagnostic
	29840	Arthroscopy, wrist, diagnostic
	29870	Arthroscopy, knee, diagnostic
ICD-9 Procedure	80.20–80.29	Arthroscopy code range
ICD-9 Diagnosis	714.4	Derangement of lateral meniscus
	717.6	Loose body in knee
	717.8	Other internal derangement of knee
	718.0	Articular cartilage disorder
HCPCS	No Code
Type of Service	Surgery
Place of Service	Inpatient Outpatient Physician’s Office

Index

Arthroscopy, office
Arthroscopy, small-field
Disposable arthroscopy

Policy History

Date	Action	Reason
12/01/95	Add to Surgery section	New policy
08/18/00	Replace policy	Archived policy
07/12/02	Replace policy	Policy reviewed without literature review; new review date only.
10/09/03	Replace policy	Policy reviewed by consensus without literature review; no changes in policy; no further review scheduled

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