Orthopedic Coding Alert

You can't report 29877 for osteoarthritis lavage alone, experts say

If your orthopedic surgeon performs arthroscopic lavage or debridement for osteoarthritic knee patients, take note: Medicare will deny these services unless your surgeon performs additional procedures for other symptoms during the same session.

Your Reimbursement Shouldn't Suffer Too Much

In black and white: CMS released its new National Coverage Determination in Transmittal 14 on June 10, which states, "Arthroscopic lavage alone for treatment of osteoarthritis of the knee, and arthroscopic debridement for presentation of knee pain only or arthroscopic debridement and lavage with or without debridement for patients with severe osteoarthritis of the knee are noncovered."
 
Because orthopedic coders fought 29877 (Arthroscopy, knee, surgical; debridement/shaving of articular cartilage [chondroplasty]) denials last year, at first glance some practices thought they might be up against similar odds this year.
 
But on closer look, the new NCD probably won't change your reimbursement too dramatically.

New Decision Makes Sense to Orthopedists

"The NCD actually does make sense in talking with some of the orthopedic physicians I know," says Annette Grady, CPC, CPC-H, healthcare consultant at Eide Bailly LLP in Bismarck, N.D. Medical research doesn't demonstrate that the procedures that the NCD affects actually help osteoarthritis patients (OA, 715.16, 715.26, 715.35, 715.96), so most physicians don't perform these surgeries unless arthritis patients also have other conditions.

Surgeons Usually Address Additional OA Dx's

"I don't think this will be a huge hassle for orthopedists," says Elisabeth P. Fulton, CPC, CCS-P, CCP, coding and auditing department supervisor at Orthopaedic Specialists of the Carolinas in Winston-Salem, N.C. "Arthroscopy is typically indicated for mechanical or inflammatory problems - not purely degenerative problems like arthritis - without additional mechanical symptoms. In my experience, arthritic patients who benefit from arthroscopy have other mechanical problems such as meniscal tears or inflammatory problems such as synovitis." So the policy barring you from collecting for 29877 for patients who only have OA shouldn't affect your bottom line.

Gather Supporting Documentation - Just in Case

Because the new NCD is so limiting, some payers may balk if you submit a debridement claim for an OA patient - even if you performed the debridement for a condition unrelated to the OA.
 
"All other indications of debridement for the subpopulation of patients without severe osteoarthritis of the knee who present with symptoms other than pain alone remain at contractor discretion," the NCD states.

Carriers May Question All Debridement for OA

Therefore, your carrier may question any debridement claim for your OA patients - even if the patients have additional problems that the carrier normally reimburses with 29877.
 
"Practices had better be prepared to have supporting documentation for the debridement services that they perform on OA patients," Grady says.
 
If your practice reports debridement during meniscal repair on an OA patient, "you need to make sure there is supporting documentation in the operative report to bill the debridement separately," she says. "And be prepared for denials that will require appeals."