Summary & Overview
CPT 29845: Arthroscopic Complete Synovectomy, Wrist
CPT code 29845 represents an arthroscopic complete synovectomy of the wrist — a specialized minimally invasive surgical procedure to inspect and excise the entire synovial lining of the wrist joint. Nationally, this code captures care for patients with chronic inflammatory arthropathies, painful synovitis limiting motion, or intra-articular masses requiring removal. Accurate coding of 29845 matters for clinical documentation, procedural tracking, and payer adjudication for musculoskeletal and hand surgery services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when 29845 is used, the typical sites of service, and common billing modifiers associated with arthroscopic procedures. The overview outlines typical use cases and the procedural scope to support correct code selection and claims submission.
This publication provides national benchmarks and policy-relevant notes, including common payer coverage patterns, billing considerations specific to arthroscopic wrist synovectomy, and where to expect authorization and documentation requirements. The material is intended for coding professionals, surgical providers, revenue cycle staff, and policy analysts seeking a focused summary of the clinical and billing dimensions of CPT code 29845.
Billing Code Overview
CPT code 29845 describes an arthroscopic complete synovectomy of the wrist. The procedure involves inserting an arthroscope into the wrist joint to inspect and remove diseased or inflamed synovial membrane; instruments are introduced to excise all synovial tissue when treating chronic inflammatory conditions, pain and motion limitation, or to remove an intra-articular tumor.
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Service type: Arthroscopic surgical synovectomy (complete synovectomy of the wrist)
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Typical site of service: Ambulatory surgical center or hospital operating room, performed under sterile surgical conditions with arthroscopic instrumentation
Clinical & Coding Specifications
Clinical Context
A 48-year-old right-handed woman with a multi-year history of rheumatoid arthritis presents with persistent wrist pain, swelling, and decreased range of motion despite optimized medical therapy. Conservative measures including oral anti-inflammatory medications, disease-modifying antirheumatic drugs, and corticosteroid injections provided only temporary relief. Physical exam demonstrates synovial thickening and tenderness over the radiocarpal joint with limited flexion-extension. Wrist radiographs show synovial proliferation without acute fracture; MRI demonstrates extensive synovial hypertrophy and inflammatory pannus within the radiocarpal joint.
The orthopedic hand surgeon schedules an arthroscopic wrist synovectomy under regional block or general anesthesia. In the operating room the surgeon introduces an arthroscope into the radiocarpal joint, systematically inspects the joint surfaces and synovium, and uses arthroscopic shavers and graspers to excise inflamed synovial tissue completely. Hemostasis is achieved, portals are closed, and a sterile dressing and splint are applied. The typical site of service is an ambulatory surgery center or hospital operating room. Postoperatively the patient recovers in PACU and is discharged with hand therapy arranged to restore motion and monitor for recurrence. Documentation includes preoperative diagnosis, informed consent, anesthesia record, arthroscopic findings, instruments used, extent of synovectomy, estimated blood loss, complications if any, and postoperative plan.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |