Arthroscopy · Knee

Arthroscopic drilling of an intact osteochondritis dissecans (OCD) lesion of the knee — cartilage is cracked but still attached to underlying bone.

Verified May 8, 2026 · 6 sources ↓

Medicare: $604.89
Total RVUs: 18.11
Global, days: 90
Region: Knee

Drawn from CMSAAPCCgsmedicareNovitasAdsc

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Operative note must confirm the OCD lesion is intact — cartilage cracked but fragment not detached from subchondral bone at time of surgery
Specify the compartment(s) examined and the exact location of the lesion (medial femoral condyle, lateral femoral condyle, patella, etc.)
Document the drilling technique used and number of drill holes placed
Record arthroscopic findings for all compartments entered, not just the treated compartment
If additional procedures were performed in the same session, document each as a distinct intervention with separate indication and anatomic site
Pre-op imaging (MRI) confirming OCD staging should be in the record to support medical necessity and lesion stability classification

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service 73 Discontinued pre-anesthesia 74 Discontinued post-anesthesia 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 29886 covers knee arthroscopy with drilling of an intact osteochondritis dissecans lesion: one where the cartilage surface is fissured or damaged but the fragment has not yet separated from the subchondral bone. The surgeon introduces an arthroscope, confirms the lesion's stability, then drills through the overlying cartilage into the subchondral bone to stimulate vascular ingrowth and promote healing of the affected area. The distinction between intact (29886) and loose or detached OCD fragments (29885, 29887) drives code selection — operative note documentation must clearly establish lesion stability at the time of surgery.

The 90-day global period applies. All routine post-op visits, wound care, and arthroscopy-related follow-up through day 90 are bundled. If you're managing an unrelated condition in that window, append modifier 24 on the E/M or modifier 79 on an unrelated procedure. When additional arthroscopic work is done in the same session — meniscectomy, chondroplasty, synovectomy — run NCCI Procedure-to-Procedure (PTP) edits first. Combinations that survive edit analysis may require modifier 59 to unbundle, but only when genuinely distinct anatomic sites or separate structures are involved. Fluoroscopy used during the arthroscopy is integral to the procedure and is not separately reportable.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.28
Practice expense RVU	8.07
Malpractice RVU	1.76
Total RVU	18.11
Medicare national rate	$604.89
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$604.89
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 29886 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Upcoding or downcoding between 29885 (loose/detached OCD), 29886 (intact OCD, drilling), and 29887 (intact OCD, drilling and grafting) due to vague operative note language
NCCI bundling conflict when 29886 is billed alongside other knee arthroscopy codes without modifier 59 and clear documentation of distinct anatomic sites
Missing or incorrect laterality modifier (LT or RT) — required by most payers for unilateral knee procedures
Medical necessity denial when pre-op MRI or clinical documentation does not support intact OCD lesion requiring surgical intervention
Global period violation — separate E/M or procedure billed within the 90-day global without appropriate modifier 24 or 79

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What is the difference between CPT 29885, 29886, and 29887?

All three address OCD lesions arthroscopically, but lesion status drives the code. 29885 is for drilling a detached or loose OCD fragment. 29886 is drilling an intact lesion — cartilage damaged but still attached. 29887 adds bone grafting to the intact lesion. The operative note must explicitly confirm stability at the time of surgery, not just rely on pre-op MRI staging.

02Can 29886 and 29879 (abrasion arthroplasty or multiple drilling) be billed together for the same knee?

This combination is subject to NCCI PTP edits. Check the CMS NCCI lookup for the current edit status. If the procedures address genuinely separate anatomic sites within the knee, modifier 59 may allow separate billing — but the operative note must document distinct sites. Billing them together for work done in the same location is not appropriate.

03Is fluoroscopy separately billable when used during 29886?

No. Per CMS NCCI policy, fluoroscopy performed during any arthroscopic procedure is integral to the procedure and cannot be separately reported.

04What modifiers are needed when 29886 is performed on both knees in the same session?

Append LT and RT to distinguish the two sides. Modifier 50 (bilateral) is an alternative if the payer accepts it for this code, but many payers prefer the LT/RT pair for orthopedic arthroscopy. Verify payer preference before submitting.

05How does the 90-day global period affect post-op management of OCD in younger patients who often need prolonged rehab?

Routine follow-up, progress checks, and rehab oversight directly related to the 29886 procedure are bundled through day 90. If the patient develops an unrelated condition requiring a separate E/M or procedure during that window, use modifier 24 on the E/M or modifier 79 on the separate procedure and document the unrelated diagnosis clearly.

06What diagnosis codes support medical necessity for 29886?

ICD-10 codes in the M93.2x range (Osteochondritis dissecans) are the primary diagnosis codes used. Laterality and site specificity (medial condyle, lateral condyle, etc.) should match the operative findings. Submitting a non-specific or mismatched diagnosis is a common cause of medical necessity denials for this code.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures lesion stability status (intact versus detached), the specific compartment and condylar location of the OCD lesion, drilling technique, number of drill holes, and arthroscopic findings across all compartments from the surgeon's dictation. This prevents the most common audit flag for 29886: an operative note that fails to distinguish an intact lesion from a loose body, which auditors use to recode down to 29877 or flag the claim for medical necessity review.

See how Mira captures CPT 29886 documentation