Coverage Policy Manual
Policy #: 2013039
Category: Medicine
Initiated: October 2013
Last Review: April 2018
  Needle Arthroscopy

Description:
An arthroscopic imaging technology utilizing an endoscopic (needle) camera proposed for use in diagnostic and operative procedures to provide visualization and obtain still or motion pictures of the articular cavity without fluid distention with local anesthesia and/or light sedation in an outpatient/office setting.  Proposed advantages include elimination of need for magnetic resonance imaging, reduced recovery time (as opposed to standard surgical arthroscopy), improved diagnostic accuracy (compared to MRI), and potential avoidance of more costly, invasive surgery.
 
Regulatory Information
The VisionScope High Definition Endoscopy Camera System received 510K approval from FDA  in September 2010 with  indicated for use in diagnostic and operative arthroscopic and endoscopic procedures to provide illumination, visualization and capture of still and motion pictures of an interior cavity of the body through a natural or surgical opening. Examples of generic surgical use include imaging of articular cavities, body cavities, hollow organs and canals.
 
The Mi-Eye, Mi-Eye 2 Monitor (Trice Medical Inc.) received FDA 510(k) clearance on September 16, 2016, Product Code HRX (arthroscope). The mi-eye 2 is indicated for use in diagnostic and operative arthroscopic and endoscopic procedures to provide illumination and visualization of an interior cavity of the body through either a natural or surgical opening.
 
Mi-Eye is used to perform in-office needle arthroscopy under local anesthesia. According to the manufacturer’s website, Mi-Eye 2™ is a handheld 2.2mm arthroscope, consisting of a needle with an integrated camera and a light source designed for in-office use. The manufacturer claims that the Mi-Eye enables physicians to provide real-time analysis, effect faster treatment, and schedule patients for surgery immediately – resulting in quicker outcomes for patients and a more efficient process for doctors.
 
Coding
There is no specific code describing needle arthroscopy.  It is anticipated that we might see the following CPT codes billed for this service:  29805, 29870, 29999.
 

Policy/
Coverage:
Needle arthroscopy (including but not limited to Mi-Eye™) does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes.
 
For members with contracts without primary coverage criteria, needle arthroscopy (including but not limited to Mi-Eye™) is considered investigational. Investigational services are specific contract exclusions in most member benefit certificates of coverage.

Rationale:
A search per PubMed through October 2013 was performed..  There are no published studies demonstrating evidence of the proposed benefits.  Most articles referenced a traditional arthroscopic procedure, not a needle arthroscopic procedure.
 
There is a completed, non-published clinical trial:  Clinical Efficacy Study Comparing VisionScope Imaging (VSI) to Magnetic Resonance Imaging (MRI) in Injuries of the Knee (VSI-001).  NCT01695720
at clinicaltrials.gov as of October 2013.
 
In 1994 Ruwe and McCarthy concluded that results of MRI imaging could be used to guide the management of knee pain.  
 
In 2008 Bridgman et all reported results of a RCT studying 252 patients on a waiting list for knee arthroscopy.  Surgeon were given MRI results for 125 patients and a blank MRI report for 127 patients. The authors made several conclusions:
    • Carefully performed clinical examination can give equal or better diagnosis of meniscal and ACL injuries in comparison to MRI;
    • MRI may be used to rule out such injuries, not diagnose them;
    • MRI has a much better NPV than PPV in both meniscal and ACL injury diagnosis;
    • When clinical signs and symptoms are inconclusive a MRI is likely to be more beneficial in avoiding unnecessary arthroscopic surgery;
    • When the clinical diagnosis favors either meniscal or ACL injuries, MRI prior to arthroscopy is unlikely to be of significance.
 
Ruwe, in a 2008 commentary, disputed several of the findings in the study noted above and he concluded:  In summary, this study does not appear to refute the long-standing belief that MRI reduces the need for arthroscopy in appropriately selected patients.
 
2014 Update
A literature search conducted using the MEDLINE database through October 2014 did not reveal any new information that would prompt a change in the coverage statement.
  
2015 Update
A literature search conducted through October 2015 did not reveal any new information that would prompt a change in the coverage statement.
 
 
2016 Update
A literature search conducted through September 2016 did not reveal any new information that would prompt a change in the coverage statement.   
 
2018 Update
A literature search conducted using the MEDLINE database through March 2018 did not reveal any studies pertaining to the Mi-eye camera enabled probe. There were no clinical trials located pertaining to the use of the Mi-eye camera. The coverage statement is unchanged.

CPT/HCPCS:
29805Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure)
29870Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)
29999Unlisted procedure, arthroscopy

References: Bridgman S, Richards PJ, et al.(2007) Magnetic Resonance Imaging did not reduce arthroscopy rates or improve outcomes for patients waiting for knee surgery. Arthrosocopy, 2007; 23:1167-73.

Crawford R, Walley G, et al.(2007) Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review. Br Med Bull, 2007; 84:5-23.

Rangger C, Klestil T, et al.(1996) Influence of magnetic resonance imaging on indications for arthroscopy of the knee. Clin Orthop Relat Res, 1996; 330:133-42.

Rappeport ED, Wieslander SB, et al.(1997) MRI preferable to diagnostic arthroscopy in knee joint injuries. A double-blind comparison of 47 patients. Acta Orthop Scand, 1997; 68:277-81.

Rayan F, Bhonsle S, Shukla DD.(2007) Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review. Int Orthop, 2009; 33:129-32.

Ruwe PA, McCarthy SM.(1994) Cost effectiveness of magnetic resonance imaging of the knee. Magn Reson Imaging Clin N Am, 1994;2:475-9.

Ruwe PA.(2008) Magnetic Resonance Imaging did not reduce arthroscopy rates or improve outcomes for patients waiting for knee surgery. Commentary. J Bone Joint Surg Am, 2008; 90:1171.

Small NC, Glogau AI, et al.(1994) Office operative arthroscopy of the knee: technical considerations and a preliminary analysis of the first 100 patients. Arthroscopy, 1994; 10:534-9.


Group specific policy will supersede this policy when applicable. This policy does not apply to the Wal-Mart Associates Group Health Plan participants or to the Tyson Group Health Plan participants.
CPT Codes Copyright © 2019 American Medical Association.