Orthopedic Coding Alert

Version 9.1 of the National Correct Coding Initiative (NCCI), which took effect April 1, bundles arthroscopic chondroplasty (29877) and foreign-body removal (29874) into several additional arthroscopic knee surgery codes. You should report the new HCPCS code G0289 if you perform these procedures in separate compartments. Following last October's highly publicized NCCI Edits that bundled chondroplasty into the meniscectomy codes (29880-29881), the new edits should cause less disruption because Medicare now accepts the recently introduced 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). The HCPCS code garners significantly less reimbursement than 29877, however, so the NCCI's new edits will probably still cause practices to lose money. Knee Arthroscopy Bundled Again Thanks to the NCCI's "0" indicator, you cannot append any modifiers to override the new knee arthroscopy code pair edits. Specifically, both 29874 (Arthroscopy, knee, surgical; for removal of loose body or foreign body [e.g., osteochondritis dissecans fragmentation, chondral fragmentation]) and 29877 (... debridement/ shaving of articular cartilage [chondroplasty]) cannot be reported under any circumstances with the following CPT codes: 29871 Arthroscopy, knee, surgical; for infection, lavage and drainage
29875 ... synovectomy, limited (e.g., plica or shelf resection) (separate procedure)
29884 ... with lysis of adhesions, with or without manipulation (separate procedure). The NCCI now bundles 29877 into the following additional codes: 29873 Arthroscopy, knee, surgical; with lateral release
29876 ... synovectomy, major, two or more components (e.g., medial or lateral)
29882 ... with meniscus repair (medial OR lateral)
29883 ... with meniscus repair (medial AND lateral). Annette Grady, CPC, CPC-H, director of reimbursement at the Bone and Joint Center in Bismarck, N.D., reminds coders that CMS established G0289 to allow practices to report separate-compartment arthroscopic procedures. Because G0289's descriptor does not limit its use to meniscectomies, you should report it along with the code for the main arthroscopic knee procedure. If you perform medial and lateral compartment synovectomies and a patellar chondroplasty, therefore, you should report 29876 and G0289. TPIs Bundled Into SI Injections NCCI now bundles the trigger point injection (TPI) codes (20552-20553) into the sacroiliac (SI) injection code (27096), although you can append modifier -59 (Distinct procedural service) to separate the two codes if the injections are unrelated. If you administer a TPI into a patient's trapezius muscle for myofascial pain and an SI injection for SI joint pain, you should report 27096 (Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid) with 724.6 (Disorders of sacrum) and 20552-59 (Injection[s]; single or multiple trigger point[s], one or two muscle[s]) with 729.1 (Myalgia and myositis, [...]