Orthopedic Coding Alert

Tip: Don't bill chondral debridement with meniscectomy or foreign body removal.

When billing the arthroscopic procedures in the knee, you'll stand a better chance of full reimbursement if you're scrutinizing the notes for these key items: which compartment your surgeon is working on, what exactly is being done, the size of the foreign body, and incisions made. An added twist is that the foreign body rules that may allow you to report the removal with chondroplasty do not always apply. See the advice below on how you will watch for the bundle in meniscectomy and foreign body removal.

Watch the Bundle In Meniscectomy and Foreign Body Removal

You will need to know the bundling of code G0289 (Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage [chrondroplasty] at the time of other surgical knee arthroscopy in a different compartment of the same knee) into 29880 (Arthroscopy, knee, surgical; with meniscectomy [medial AND lateral, including any meniscal shaving] including debridement/shaving of articular cartilage [chondroplasty], same or separate compartment[s]), when performed) and 29881 (Arthroscopy, knee, surgical; with meniscectomy [medial OR lateral, including any meniscal shaving] including debridement/shaving of articular cartilage [chondroplasty], same or separate compartment[s], when performed) as per different sources of edits (CMS, AAOS, and others).

As per current NCCI edits, there is no bundling of code G0289 into codes 29880 and 29881, but logically it should bundle. "The bundling of code G0289 into codes 29880 and 29881 certainly gives the appearance that Medicare no longer allows either loose body/foreign body removal or chondroplasty to be reported in addition to meniscectomy," says Heidi Stout, BA, CPC, COSC, PCS, CCS-P, Coder on Call, Inc., Milltown, New Jersey and orthopedic coding division director, The Coding Network, LLC, Beverly Hills, CA. "However, bundling loose/foreign body removal into meniscectomy goes beyond the changes CPT® made to the descriptions of codes 29880 and 29881," she adds.

Special exception: "Codes 29880 and G0289 can only be billed together if billing for a loose body in the patellofemoral compartment," says Ruby O'Brochta-Woodward, BSN, CPC, CCS-P, COSC, ACS-OR, compliance and research specialist, Twin Cities Orthopedics, P.A.

Going further in 2012, you should exercise care that you do not report 29877 (Arthroscopy, knee, surgical; debridement/shaving of articular cartilage [chondroplasty]) with 29880 and 29881. "CPT® specifically disallows reporting of 29877 for chondral debridement with 29880 and 29881," says Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner, Precision Auditing and Coding, senior orthopedic coder & auditor, The Coding Network, Washington.

Review Medicare requirements carefully, experts stress. "Some private payers may still allow this reporting combination for loose body excision greater than 5 mm AND/OR removed through a separate incision, as outlined in the AAOS GSDG. AAOS has not changed their recommendations for 2012 for the loose body excisions -- they are still listed as separately reported, if the conditions are met," says Stout.

Similarly, the bundling of G0289 and 29874 (Arthroscopy, knee, surgical; for removal of loose body or foreign body [e.g., osteochondritis dissecans fragmentation, chondral fragmentation]) is going to be another challenging situation for you. You cannot bill them together and there isn't a modifier you can turn to. "Of great concern to the orthopedic community is the CPT® edit that has been created for including chondroplasty in with the meniscectomy codes. This has resulted in a billing quandary for knee arthroscopies that involve a meniscectomy and removal of loose body as both 29874 as well as G0289 are both considered bundled with no modifier allowed," she adds.

Caution: If arthroscopic removal of the loose body was the only procedure that your surgeon performed, then the size or separate incision criteria do not apply. "In this scenario, you would report code 29874," says Stout.

You should not report G0289 and 29874 together. "The reporting of G0289 and 29874 would only be appropriate in the rare occurrence where loose body excision is the only procedure being performed and both removals meet separate reporting guidelines of greater than 5 mm AND/OR through separate incisions," says Stumpf. Separate compartment loose bodies would likely also be a requirement for the majority of carriers," she adds.

Be Proactive With Payers

"It is imperative that the providers continue to bill for removal of loose bodies when appropriate and appeal," says O'Brochta-Woodward. "Providers, however, need to be aware that the definition of G0289 is that the loose body is in different compartment versus the AAOS edit, which allows for the billing of 29874 if the loose body is greater than 5 mm or through a separate incision," she notes.

And be sure to verify your payer preferences. "Work with your carriers to determine when these procedures can be separately reported and to determine the billing methodology the carrier prefers for separate reporting (i.e. separate compartment, greater than 5 mm AND/OR through separate incision)," says Stumpf. "Many carriers publish guidance on their websites for proper use of G0289. Be sure to reference the payers website for guidance" or your carrier representative, she advises.

"If you have trouble attaining guidance, consider addressing your query to the Medical Director for guidance in writing. It is always strongly recommended to have guidance of this nature in writing when at all possible."

What to send: "Use the AAOS guidance as support in your appeals for your carriers that follow private payer reporting guidelines and submit a highlighted operative report for your appeals, when a written appeal is necessary," says Stumpf. "If you have written guidance from the website, your carrier representative, or perhaps the Medical Director, include this documentation with your appeal(s)."

(Editor's Note: For more on arthroscopic chondroplasty and loose body removal, see Orthopedic Coding Alert, Vol. 15, No. 4 and Vol.15, No. 5.)

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