Orthopedic Coding Alert

The new edition of the Correct Coding Initiative (CCI), which took effect on Oct. 1, prohibits practices from appending modifier -59 (Distinct procedural service) to 29877 (Arthroscopy, knee, surgical; debridement/shaving of articular cartilage [chondroplasty]) when performed with meniscectomies (29880-29881).

With CCI version 8.3, Medicare no longer recognizes three knee compartments. The edit now contains a "0" identifier, indicating that you cannot report the two services together on the same date for the same patient under any circumstances. Until now, you could use modifier -59 to designate the difference between the two services. Despite previous CCI edits bundling chondroplasty into meniscectomies, Medicare reasoned that certain circumstances such as a medial meniscectomy with patellar chondroplasty warranted using modifier -59 to allow payment for both. CCI's new take, however, comes as a surprise to most orthopedic practices because they stand to lose significant reimbursement. Fight the Edit "This change will create a significant negative economic impact on surgeons. Obviously, they aren't going to alter their clinical practice and subject their patients to a second operative procedure, so they'll have to take a hit financially," says Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopaedic Associates in New Brunswick, N.J. Stout advises practices to fight the denials vehemently.

"I would urge coders and orthopedists not to take this lying down, as doing so will set the table for future financially motivated CMS actions of this nature," Stout says. "Practices should continue to submit claims according to the American Academy of Orthopaedic Surgeons (AAOS) guidelines and appeal each and every inappropriate denial. When the appeals department and fair-hearing officers have piles of review letters on their desks, maybe the message will get through that surgeons will not simply accept inappropriate edits."

According to the AAOS Complete Global Service Data for Orthopaedic Surgery, the global service package for 29881 includes the following procedures: Articular shaving, debridement, and/or chondroplasty in the same compartment, e.g., 29877, 29879 Plica and/or synovial resection, e.g., 29875 Debridement and/or shaving of meniscus Debridement and/or shaving of cruciate stump Knee arthroscopy, diagnostic, e.g., 29870 Additional portal(s) or enlarging portal(s) Meniscal tissue removal Knee lavage and/or drainage, e.g., 29871. Note that the AAOS guidelines do not include chondroplasties that occur in other compartments with the fee for meniscectomies. Injections Bundled Into One Another CCI 8.3 also bundles most injection codes into other, more extensive procedures with which they are normally performed. For instance, the new edits bundle trigger point injection codes (20552-20553) into many of the nerve block codes (64400-64530).

Although these edits are new to CCI, many carriers have been bundling injections into other procedures for years, and version 8.3 merely makes the trend official. This does not necessarily mean, however, that your [...]