Medicare Compliance & Reimbursement

Say goodbye to 50-percent pay cut for G0289.

You can look forward to $48 more in reimbursement when you report G0289 with your chondroplasty claims, thanks to a new Medicare Transmittal.

On Sept. 1, the Centers for Medicare & Medicaid Services (CMS) issued Transmittal 1047, which changes the multiple surgery payment indicator for code G0289 (Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage [chondroplasty] at the time of other surgical knee arthroscopy in a different compartment of the same knee) from "2" to "0." This means that as of Oct. 2, Medicare carriers will no longer take the multiple procedure discount of 50 percent when you report G0289 with other procedures.

Because you cannot report G0289 as a stand-alone procedure, this change means that every time you bill G0289, you will collect twice the reimbursement that you collected in the past.

Medicare doesn't pay enough in general for orthopedic procedures, so "receiving 100 percent of the allowable is huge," says Margaret Atkinson, business manager with Centennial Surgery Center.

Unfortunately, the volume of cases where this change will have an impact under Medicare is relatively low for Centennial, says Atkinson. But since many other insurance companies copy Medicare's policies, this means that other payers may soon start paying 100 percent for the procedure as well. And that will mean a much bigger reimbursement boost to Centennial.

Contact your non-Medicare payers: Make sure they know about the change to Medicare policy, experts urge. Review your contracts with insurance companies to make sure they follow Medicare rules, says Atkinson. Also, make sure they actually pay 100 percent of the allowable for add-on codes and 50 percent for secondary procedures. Also, check whether other payers accept HCPCS codes at all.

Resource: To read the full Transmittal, visit the CMS Web site at www.cms.hhs.gov/transmittals/downloads/R1047CP.pdf.