Orthopedic Coding Alert

CMS adds arthroscopic knee lateral release to endoscopic knee group Thanks to a new Medicare transmittal, you could be looking at about a $150 pay cut when you perform arthroscopic knee lateral releases (29873) with other knee procedures in the endoscopic base family of 29870.

How is that possible? CMS recently changed the way practices should report 29873 (Arthroscopy, knee, surgical; with lateral release).

Old way: In the past, if your practice reported 29873 with another arthroscopic knee procedure, such as 29880 (...with meniscectomy [medial AND lateral, including any meniscal shaving]), Medicare payers subjected the lower-valued procedure to the "multiple-procedure rule." Medicare paid the first procedure at the full relative value unit (RVU) allowable rate but discounted the second procedure by 50 percent.

New way: Now, however, if you report 29873 with any other code in the 29870-29887 range, you'll be subjected to Medicare's multiple-endoscopic-procedure rule, not the multiple-procedure rule. Multiple-Procedure Rule No Longer Applies Medicare Transmittal 558, which carries an effective date of Jan. 1, 2005, and an implementation date of July 5, instructs carriers to change 29873's multiple-procedure indicator from a "2" (which meant that standard multiple- procedure rules applied) to a "3," which means that special rules for multiple endoscopic procedures apply if you bill the procedure with another endoscopy in the
same family.  Multiple-Procedure Rule Paid More Multiple endoscopic rule basics: The Medicare Carriers Manual states, "For multiple endoscopic procedures, use the full value of the highest valued endoscopy plus the difference between the next highest and the base endoscopy."

The base code in the knee family (29870) carries 10.78 RVUs (not including geographic adjustments). Therefore, if you bill 29873 with 29883 (Arthroscopy, knee, surgical; with meniscus repair [medial AND lateral]), your Medicare carrier will reimburse you using the full RVU allocation for 29883 (21.98 RVUs, or about $833).

The payer will then pay you just 2.81 RVUs for 29873. The insurer would calculate this figure by subtracting 29870's 10.78 RVUs from 29873's 13.59 RVUs. Medicare carriers then multiply the RVUs by the conversion factor of 37.8975 to come up with the procedure's value, which would total about $106:

13.59 RVUs for 29873 - 10.78 RVUs for 29870 = 2.81
2.81 x conversion factor of 37.8975 = $106. Using the previous payment rules, you would have collected the full $833 for 29883, and about $257 for 29873 (50 percent of the $515 allotted for 29873). Therefore, you'll now be about $150 short if you report 29873 with other codes in the 29870 base family.

It's not endoscopy, but the rules apply: "Coders may wonder why the multiple-endoscopy rule applies to arthroscopies," says Angela Daniels, RN, office manager for Thomas Daniels, MD, in Seattle. "You just have to keep an eye on the [...]