Review of knee arthroscopic practice and coding at a major metropolitan centre

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Arthroscopic surgery of the knee may be performed with both diagnostic and therapeutic intent. Arthroscopy is a highly sensitive and specific tool in confirming internal derangement of the knee.1 However, purely diagnostic arthroscopy has become increasingly uncommon with the advent of magnetic resonance imaging (MRI), which is associated with decreased cost and surgical risk.4 The use of diagnostic arthroscopy may however be prudent for specific indications in prosthetic knees.5
The use of therapeutic arthroscopy is controversial following a number of publications showing no benefit of debridement over placebo in undifferentiated knee osteoarthritis (OA).6 Despite this, varied opinions persist amongst surgeons as to the place of arthroscopic intervention in the osteoarthritic knee.9 A review of Victorian data identified that rates of knee arthroscopy had decreased overall in the period 2000–2009, but increased in those with a concurrent diagnosis of OA.10 A similar study in New South Wales concluded that there had been no change in the rate of knee arthroscopy.11 Both studies identified that over 70% of knee arthroscopy is performed in the private sector.
Most recently the efficacy of knee arthroscopy in the treatment of meniscal tears has been disputed.12 For patients with degenerative meniscal tears, a number of randomized controlled trials have found no benefit of arthroscopic partial meniscectomy over physical therapy – both in cohorts with12 and without significant OA.13 Another study comparing arthroscopic partial meniscectomy to sham surgery in patients with symptoms of degenerative meniscal tears also found no benefit.15
Given these findings, a number of groups have attempted to review current arthroscopic practice. In attempting to analyse trends in knee arthroscopy, Victorian Admitted Episodes Dataset (VAED) or Centre for Health Record Linkage (CHeReL) data have been used in published studies.10 The International Classification of Diseases 10, Australian Modification (ICD10‐AM) codes here used may not be an accurate reflection of the indications for arthroscopic surgery as the codes are representative of the procedure performed rather than the rationale, and are often input by hospital coders rather than by the operating surgeon. Furthermore, given more complex procedure codes carry higher remunerations,16 there may exist incentive in both public and private practice to overstate procedure codes.
The aim of this study was to (i) quantify the use of diagnostic and interventional arthroscopy occurring at a major metropolitan public teaching hospital; and (ii) describe patterns of reporting using Medicare Benefits Schedule (MBS) codes at this institution by comparing a sample of codes assigned by an orthopaedic registrar, hospital coding staff and the auditor.
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