# Loose bodies removal



## Robbin109 (Aug 21, 2013)

Pt has tear of medial and lateral meniscus of left knee
along with loose bodies.

MD performs a Medial and Lateral Meniscectomy (29880) and also removes loose bodies from the medial compartment (5mm X6mm) can this also be billed (29874)

Pt has a HMO insurance.

Thanks!!


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## npricercm (Aug 21, 2013)

Robbin109 said:


> Pt has tear of medial and lateral meniscus of left knee
> along with loose bodies.
> 
> MD performs a Medial and Lateral Meniscectomy (29880) and also removes loose bodies from the medial compartment (5mm X6mm) can this also be billed (29874)
> ...



Just follow this link, it has great information
http://www.aaos.org/news/aaosnow/may10/managing2.asp

_code 29874 (Arthroscopy, knee, surgical; for removal of loose body or foreign body [eg, osteochondritis dissecans fragmentation, chondral fragmentation]) may be reported in addition to other arthroscopic knee procedures, including arthroscopic chondroplasty and arthroscopic microfracture, if either of the following requirements are met:

    The arthroscopic loose/foreign body was greater than 5 mm or
    The loose/foreign body was removed through a separate incision or portal (not through the inflow or outflow portal) 

If arthroscopic removal of loose/foreign bodies was the only procedure performed, the size or separate incision guidelines do not apply. _


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## scooter1 (Aug 22, 2013)

You will  probably have to change 29874 to G0289.


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## Robbin109 (Aug 22, 2013)

*npricercm,*
It doesn't appear to be a separate incision or portal, it says:

"The medial compartment was noted to be frayed with early degenerative changes. cartilage also had the calcium deposits in it.

There was a tear of hte posterior horn of the medial meniscus that measured 5mm x 6mm in size.

A loose body was grasped with a grasper and removed.

The 4.5 shaver was insertedm, the meniscal tissue trimmed and a large amount of the hypertrophic synovial tissue was clacium within was removed."

(..he went on to shave the lateral meniscus)

I believe the code shoulde just be 29880, but 29874 was also coded with this.

What do you think?

*scooter1,*
 thought G0289 was just for Medicare?

Thanks!


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## Robbin109 (Aug 25, 2013)

Since the loose body was greater than 5mm it could be coded even though it was the same compartment as the meniscectomy?


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## Robbin109 (Aug 25, 2013)

A separate report mentions:

"The lateral compartment was examined. There was a vertical tear in the mid portion of the lateral meniscus. This was trimmed back to a healthy meniscal tissue. Loose body was then retrieved from the lateral compartment, taken out through one of the anteromedial portal."

He doesn't mention the size, but is this a separate a portal? Can this one be coded?


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## nyyankees (Aug 26, 2013)

Robbin109 said:


> A separate report mentions:
> 
> "The lateral compartment was examined. There was a vertical tear in the mid portion of the lateral meniscus. This was trimmed back to a healthy meniscal tissue. Loose body was then retrieved from the lateral compartment, taken out through one of the anteromedial portal."
> 
> He doesn't mention the size, but is this a separate a portal? Can this one be coded?



AAOS has stated that if thru separate portal or >5mm it is separately reportable with a 59 modifier. Just be prepared that carriers are bundling (even w/supporting documentation) and some may request G0289 which pays pennies on the dollar. You may find that the amount of time and energy is not worth reporting but I also have and followed the appeal process to show my docs that we did our part before we w/o.


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## Robbin109 (Aug 26, 2013)

So how can I tell if the anteromedial  is a separate portal?

Also, it can be the same compartment as other procedure as long as it is at least 5mm?


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