Orthopedic Coding Alert

Orthopedists who perform chondroplasty (29877) and meniscectomies (29880-29881) in separate compartments can once again recoup reimbursement from Medicare for both procedures by using the new 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) in place of 29877.

Orthopedic coders were shocked last October when the Correct Coding Initiative (CCI) announced it would no longer allow practices to append modifier -59 (Distinct procedural service) to separate-compartment chondroplasty claims (29877, Arthroscopy, knee, surgical; debridement/shaving of articular cartilage [chondro-plasty]) when physicians perform the procedure with meniscectomies.

Effective for services rendered on or after Jan. 1, 2003, orthopedic practices should report G0289 when the orthopedist performs chondroplasty and other arthro-scopic procedures in separate compartments of the same knee. For instance, if the physician performs a medial meniscectomy with patellar chondroplasty, report 29881 (Arthroscopy, knee, surgical; with meniscectomy [medial OR lateral, including any meniscal shaving]) with G0289.

Report It Once per Compartment

Although G0289 is not preceded by a +"" indicator" CMS considers it an add-on code. The Dec. 31 2002 Federal Register states that G0289 "should be added to the knee arthroscopy code for the major procedure being performed."

"Because G0289 is very detailed and lists loose-body and foreign-body removal as well as chondroplasty CMS perhaps thought that coders would bill three units of it if the surgeon performed all of these tasks " says Gina Rinaldi CPC an independent coding consultant in Atlanta. "Therefore the Federal Register explanation specifically directs coders to report G0289 only once per extra compartment."

Practices can report G0289 twice (or as two units) if the surgeon performs chondroplasty in two separate compartments other than the compartment where he or she performed the main arthroscopic procedure. For instance if the surgeon performs a medial meniscectomy with patellar and lateral chondroplasties report 29881 with G0289 x 2.

"Only report G0289 if the orthopedist spends at least 15 minutes performing chondroplasty in the separate compartments " Rinaldi says. "In the Federal Register Medicare also prohibits coders from billing G0289 if a complication from the main arthroscopic procedure created the need for chondroplasty."

CMS Halves Reimbursement

Although the new chondroplasty code pleases orthopedic practices that feared they would have to write off the cost of chondroplasty performed in separate compartments reimbursement for G0289 does not come close to what practices collected for 29877.

"Medicare assigned 2.33 total relative value units (RVUs) to G0289 as opposed to 15.19 for 29877 " says Heidi Stout CPC CCS-P coding and reimbursement manager at University Orthopaedic Associates in New Brunswick N.J. "If you apply Medicare's multiple endo-scopy/arthroscopy rules to 29877 it would garner 4.45 RVUs when billed with a secondary arthroscopic procedure. In essence CMS has cut reimbursement for chond-roplasty in a separate compartment by almost 50 percent."

Although coders must report G0289 instead of 29877 to Medicare for these claims private insurers may observe the American Academy of Orthopaedic Surgeons (AAOS) guidelines instead of following CCI edits. Because the AAOS does not bundle separate-compartment chond-roplasties into meniscectomy claims practices can continue to report 29881 with 29877-59 to these other payers.