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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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