Orthopedic Coding Alert

A coding edit in Correct Coding Initiative version 8.0 (CCI 8.0), in effect Jan. 1-March 31, 2002, caused major concern among orthopedic coders, who felt the code bundling was out of line with other CCI edits, American Academy of Orthopaedic Surgeons (AAOS) guidelines and conventional coding wisdom.
 
As a result, CCI has recalled the edit, effective April 1, 2002.
 
The edit that raised concerns: Code 29877 (Arthroscopy, knee, surgical; debridement/shaving of articular cartilage [chondroplasty]) is bundled with 29880 (... with meniscectomy [medial AND lateral, including any meniscal shaving]) and 29881 (... with meniscectomy [medial OR lateral, including any meniscal shaving]) and assigned a "0" modifier indicator to the edit, meaning modifier -59 (Distinct procedural service) cannot be used to bypass the edit.
 
AAOS guidelines for knee arthroscopy indicate that "articular shaving, debridement, and/or chondroplasty in the SAME compartments" of the knee are included in the major arthroscopy and are not separately billable.
 
But traditionally, when a chondroplasty is performed in a compartment other than the one being arthroscopically repaired, the coder could append modifier -59 to 29877 and bypass the edit.
 
Documentation of the surgery and reason for the chondroplasty accompanied the claim, and reimbursement was never a huge battle.
 
Due to an error in the CCI edit, "0" was listed as the modifier indicator rather than "1." The next version of CCI will list a "1" modifier indicator next to the code bundle, allowing for the bypass.
 
Although the change will not take effect until April 1, 2002, continue to submit the billing for the chondroplasty when it is legitimately separate from the arthroscopy.
 
When the repeal takes effect, claims that were denied can be rebilled under the new rule. If the claims were not submitted in the first place, however, they cannot be "rebilled" once the rules change.