# medial menisectomy only?



## BFAITHFUL (Aug 9, 2009)

So i have the doctor saying he performed a medial menisectomy only? but please read the following?   

the medial meniscus was inspected and palpated and found to have a horizontal cleavage tear at the mid to posterior horn, there was also some tearing of the medial border of mid to posterior horn.  this was present through the medial infrapatellar arthroscopic portal.  the arthroscopic shaver was introduced and the tear was resected followed byuse of the Mitek radiofrequency probe to sculpt this down to a stable edge. 

then he goes to the lateral compartment & dictates:

there was noted to be some slight degenerative fraying of the medial border of the lateral meniscus. however no tears were found on palpation of the superior and inferior articular surfaces and the popliteal hiatus was inspected and found to be intact.  The Mitek radiofrequency probe was then used to sculpt the medial border down to a stabilize edge.     

So no lateral meniscal tear is mentioned but can't I bill for a chondroplasty 29877?


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## banderson77 (Aug 10, 2009)

You cannot bill the chrondroplasty because it is bundled per the CCI and cannot be unbundled.


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## kibbit99 (Aug 11, 2009)

You can bill 29877 since it is in a seperate compartment with a 59 modifier.  Some insurances perfer G0289(Medicare Rules).  Please check with the insurance guidelines.  

List of compartments;

Lateral
Medial
Patellafemoral

Kim, CPC


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## kibbit99 (Aug 11, 2009)

Also, here is the note from one of Karen Zupko's Seminars

A meniscal repair and chondroplasty done in the same compartment are considered "included" and not separately reportable.  However, when done in separate compartments, the chondroplasty is separately reportable with the modifier 59 (per CPT rules) appended to indicate a distinct procedure service.  Remember that according to CPT rules, a chondroplasty is only reported onece, regardless of how many areas are debrided or shaved.  Accurate diagnosis coding and linking of diagnoses to procedures is important.


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## BFAITHFUL (Aug 11, 2009)

I thought I could bill the chondroplasty separately but another thing I just noticed, since I work at an ASC I only have the op report, & as far as the diagnosis goes, it only states, degenerative fraying in the body of report??


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## coderguy1939 (Aug 11, 2009)

Look at the 717.4x codes for lateral compartment degenerative meniscus.  Also, you may want to take a closer look at 29881/29880 which includes meniscal shaving.


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## BFAITHFUL (Aug 11, 2009)

that's what I am trying to find out, I shouldn't bill for 29880 b/cuz that is both medial & lateral,  but he states there is no tears of the lateral mensicus, so to me he did not do a mensiectomy but only shaving of medial border of the mensicus (not menisectomy),  so not sure if this should count as a chondroplasty??


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## kibbit99 (Aug 11, 2009)

The description of 29877 in Ortho Companion indicates the cartilage can be frayed, but it states repair is done by motorized suction cutter or shaver *and *use of probe. Our office never used this Mitek device, so I am not exactly sure what it looks like and how it sculpts.  If this probe is similar to the standard probe, I would say this is not separately billable since a shaver or cutter must be involved.  

717.4x range would be good for dx code.

I hope this helps


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## mbort (Aug 11, 2009)

The note states that there was degenerative fraying of the medial border of the lateral meniscus and he stabilized it.

29880  
Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral,* including any meniscal shaving)  *


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## BFAITHFUL (Aug 12, 2009)

now he says he wants to bill cpt 29881 because its an MVA case, & the medial meniscus tear is the injury related to MVA, so now Im just not sure how to bill for this, should I just bill 29881, or should he have done two separate op notes, I mean Im confused, how can I split this case , if even possible?


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## kibbit99 (Aug 12, 2009)

29880 includes medial and lateral meniscectomy.  His op is not significant enough to bill a repair of the meniscus.  Sounds fraudulent since he wants to bill a lateral meniscectomy now.  

He would need do an addendeum if the op does not state MVA related.  The Medial and lateral tears would be billed to MVA then, but he did not do the "typical repair of the lateral."  Maybe try to billl it to the MVA with a 22 modifier on the lateral.    The catch is you would be reducing the fee for the medial too since 29880 covers both.  

I would advise him on the situation and see what he suggests. He might be better off billing 29880 and 29877-59 vs 29880-52.  He needs to dictate more of the lateral procedure to get that paid at full price.  

Good luck!


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## mbort (Aug 12, 2009)

kibbit99 said:


> 29880 includes medial and lateral meniscectomy.  His op is not significant enough to bill a repair of the meniscus.  Sounds fraudulent since he wants to bill a lateral meniscectomy now.
> 
> He would need do an addendeum if the op does not state MVA related.  The Medial and lateral tears would be billed to MVA then, but he did not do the "typical repair of the lateral."  Maybe try to billl it to the MVA with a 22 modifier on the lateral.    The catch is you would be reducing the fee for the medial too since 29880 covers both.
> 
> ...



29880 is not for a repair so that wont even come into play, its only for meniscectomy/debridement of the meniscus.

I would suggest just the 29880 to whichever carrier, send the op note, and a letter from the doc stating which part is related to the MVA and let the insurance carrier work out the logistics with the other payor.

An addendum would be nice too.  This op note really does stink!


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## BFAITHFUL (Aug 12, 2009)

thanks guys!!!!


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## coderguy1939 (Aug 12, 2009)

If the medial tear was caused by an accident, use the traumatic code, 836.0.  If the lateral side is old and degenerative, use the 717.4x codes.  Are there two carriers involved?


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## BFAITHFUL (Aug 13, 2009)

No, not that I know of, I only have the MVA insurance  carrier, that's why I was confused.


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## kevaro (Aug 13, 2009)

You can bill the 29881 because it states Med or Lat menisectomy.


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## coderguy1939 (Aug 13, 2009)

If the doctor performed a medial menisectomy for the injury it seems to me that the MVA carrier would be responsible for that part of the surgery.  Did the doctor discuss the possibility of additional work being done?  I'm not a biller, but what are the possibilities of billing the patient's insurance for the shaving of the old degenerative fraying of the lateral meniscus?  Any other opinions on this?


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## mbort (Aug 14, 2009)

I think that would be double dipping which is why I suggested letting the two carriers work out the payment differential.


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## coderguy1939 (Aug 14, 2009)

No, I agree with you, Mary,  that 29880 should be used and the letter sounds like a good solution, but according to Bfaithful there only seems to be one carrier in the picture at the moment.


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## mbort (Aug 14, 2009)

oh...i'm feeling kinda blonde...why did I think there were two carriers??  ok..well then...if the doc only wants to bill 29881 then he's leaving money on the table.  This note supports 29880.


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## BFAITHFUL (Aug 14, 2009)

I know, I agree with both of you, I think I will just bill 29881 even though he's leaving money on the table, because I bill for ASC & he keeps insisting on only billing the 29881 since medial is the only injury related to MVA, 

Thanks again you guys are the best!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
What would I do without all of you!!


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