Medicare Compliance & Reimbursement

Knee surgeons starting to use pain pumps? Check question 3. As many as 300,000 Americans tear or rupture an anterior cruciate ligament each year. But the fact that arthroscopic ACL surgery is common doesn't mean coding the procedure is straightforward. Tackle some of the variations that arise in ACL procedures with these five expert tips. Tip 1: Think 29999 for Thermal Shrinkage Question: How should I report arthroscopic ACL thermal shrinkage? Answer: Some surgeons use thermal treatments to tighten a stretched ACL. CPT does not offer a particular code for thermal shrinkage, so if the procedure is performed entirely with thermal shrinkage you should use 29999 (Unlisted procedure, arthroscopy), says Annette Grady, CPC-Ortho, CPC-H, CPC-I, CPC-P, CCS-P, PCS, FCS, senior orthopedic compliance auditor with The Coding Network and coding consultant. The medical community has noted that thermal shrinkage isn't always successful, so you're unlikely to see a dedicated code for this procedure in the future, notes Terry Fletcher, CPC, CCS-P, CCS, CPC-EM, CPC-Cardio, CMSCS, CMC, a healthcare coding consultant in Laguna Beach, CA. And studies have shown the ACL eventually stretches back out over time after this procedure, Grady says. So, many carriers consider thermal shrinkage procedures experimental or not medically necessary and do not reimburse for this service. Tip 2: Keep an Included/Excluded Procedure Checklist Question: May I report 29880 (Arthroscopy, knee, surgical; with meniscectomy [medial AND lateral, including any meniscal shaving]) with 29888 (Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction)? Answer: You should be able to report these codes together. According to the American Academy of Orthopaedic Surgeons, ACL reconstruction (29888) does not include knee arthroscopy codes 29874 and 29877-29883. Remember: For non-Medicare patients, the AAOS Global Service Data book says that to report 29874 (Arthroscopy, knee, surgical; for removal of loose body or foreign body [e.g., osteochrondritis dissecans fragmentation, chondral fragmentation]), you should have documentation of "arthroscopic removal of loose or foreign bodies greater than 5mm or through a separate incision," Grady says. CCI sidenote: Correct Coding Initiative edits bundled 29880 into 29888 at one point, but CCI deleted the edit retroactive to its creation date: Jan. 1, 1996. However, CCI still bundles 29874 and 29877 (Arthroscopy, knee, surgical; debridement/shaving of articular cartilage [chondroplasty]) into 29888. So, expect these bundles if your payer requires you to apply CCI guidelines to your claims. Example: The surgeon performs an arthroscopic-aided ACL repair and performs medial meniscus repair and partial lateral meniscectomy. You should report 29888 for the ACL repair, 29882-51 (Arthroscopy, knee, surgical; with meniscus repair [medial OR lateral]; multiple procedures) for the medial meniscus repair and 29881 (... with meniscectomy [medial OR lateral, including any meniscal shaving]) for the partial lateral meniscectomy. Remember, only report modifier 51 to [...]