Orthopedic Coding Alert

When the surgeon performs knee arthroscopy, you-ll have to consider a few key points before you submit your claim. Refresh your memory with these quick guidelines.

When your surgeon performs an arthroscopic medial or lateral meniscectomy, you-ll report the appropriate meniscectomy code, such as 29881 (Arthroscopy, knee, surgical; with meniscectomy [medial OR lateral, including any meniscal shaving]). Or if the physician performs the meniscectomy in both the medial and lateral compartments, you-d report 29880 (Arthroscopy, knee, surgical; with meniscectomy [medial AND lateral, including any meniscal shaving]), says Susan Vogelberger, CPC, CPC-H, CMBS, CCP, owner/president of Healthcare Consulting & Coding Education LLC in Boardman, Ohio.

If the physician performs chondroplasty in a separate compartment during the same session as the meniscectomy, you should report the chondroplasty as well with 29877 (Arthroscopy, knee, surgical; debridement/shaving of articular cartilage [chondroplasty]). But be careful: the Correct Coding Initiative (CCI) edits do not allow you to report 29877 with either 29880 or 29881.

Since Jan. 1, 2003, Medicare requires that you use 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) to represent the chondroplasty charge when the physician performs both chondroplasty and meniscectomy in separate compartments on a Medicare patient during the same session.

Medicare does not dictate a specific amount of time that the surgeon must spend performing chondroplasty, but the physician must be specific in his documentation, noting which compartments he addressed.

Some private payers also request that you report G0289 with the meniscectomy code, although most non-Medicare insurers still accept the meniscectomy code followed by 29877-59 (Distinct procedural service) if they do not follow CCI edits.

"There are three billable compartments of the knee: the medial, the lateral and the patellofemoral," Vogelberger says. Per the CCI bundle, only one code may be billed per compartment.

Watch out: Some physicians may use different words to describe the patellofemoral compartment, says Denise Paige, CPC, billing department manager at Torrance Orthopedic and Sports Medicine Group in Torrance, Calif., and president-elect of the AAPC Long Beach Chapter. "As a coder, you have to familiarize yourself with the different terms that you are reading in the op note," she says. "When you hear the words -groove,- -intercondylar notch- or -trochlea,- these are all part of the patellofemoral compartment."

Billing for the different compartments can be tricky, especially when billing for both chondroplasty and meniscectomy. Again, the CCI edits do not allow billing 29877 (chondroplasty) with 29880 or 29881 (meniscectomy), and it's one edit that is not allowed to be bypassed with a modifier. The only time that you could bill 29877 with 29880 or 29881 to an insurer that follows CCI would be if the surgeon performed the chondroplasty in the contralateral knee.

For example: If the physician performed a mensicectomy in the right knee and a chondroplasty in the left knee, you could code:

- 29877-LT

- 29881-RT.

"Too many practices are billing this wrong, and it will cause them to be audited and pay back," Vogelberger says.

There is some debate around using 29879 (Arthroscopy, knee, surgical; abrasion arthroplasty [includes chondroplasty where necessary] or multiple drilling or microfracture) and whether you can bill it "by compartment" or whether you can use the code only once per knee, no matter how many compartments the surgeon addresses, Paige says. Although Paige has heard conflicting information, she codes per compartment, instead of per knee.

Remind your physicians to carefully document the patient's condition, and be sure that the ICD-9 code provides medical necessity for each procedure performed, Vogelberger says.

"Diagnosis codes verify medical necessity, so with multiple procedures, they are important in order to get all the procedures paid," Paige says.

"It's helpful to know when dealing with meniscal tears if they are acute or degenerative, medial or lateral, if there's any chondromalacia involved in the knee, any arthritis, etc," Paige says. So read your op notes carefully to accurately document medical necessity and help ensure full payment.

Documentation tip: Some surgeons list each compartment in a separate paragraph and label each paragraph with the terms "Medial Compartment," "Lateral Compartment," etc. These surgeons then dictate the portion of the procedure they performed in each compartment in that labeled paragraph. This process allows the coder and insurer to more easily determine which procedures the physician performed in each compartment, as follows:

Medial compartment:-Finding was a flap tear of the posterior horn of the medial meniscus.-This was debrided down to a stable rim using a motorized shaver.-Probe confirmed stability of the remainder of the meniscus.

Lateral compartment:-Finding was a 1-cm x 1-cm osteochondral defect on the lateral femoral condyle.-This was debrided down to a stable rim using a motorized shaver.-Drill was then used to perform microfracture of the defect, making multiple small drill holes in the base of the defect.

Patellofemoral compartment:-Finding was a small loose body in the patellofemoral compartment, which measured 1 cm x 1 cm.-An additional accessory portal was created and the loose body was removed with a grabber.