Orthopedic Coding Alert

Question: We are trying to get a large loose body (over 5 mm) removal paid that occurred during a 29880 service. We billed 29874 with 29880, but Medicare denied 29874 because of Correct Coding Initiative (CCI) edits. Our global billing book states 29874 is not included if the loose body removed was greater than 5 mm. Does G0289 cover this situation? New Jersey Subscriber Answer: The American Academy of Orthopaedic Surgeons (AAOS) global service data book does say that you may report separately "arthroscopic removal of loose or foreign bodies greater than 5mm and/or through a separate incision." But payer guidelines take precedence. Medicare states, "We will not allow billing of CPT codes 29874, Arthroscopy, knee, surgical; for removal of loose body or foreign body (e.g., osteochrondritis dissecans fragmentation, chondral fragmentation) and 29877, Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chrondroplasty) with other arthroscopic procedures on the same knee" (Transmittal A-02-129, http://www.cms.hhs.gov/Transmittals/Downloads/A02129.pdf). That means you won't be able to report 29874 with 29880 (- with meniscectomy [medial AND lateral, including any meniscal shaving]) to Medicare. And, unless the procedures took place in different compartments, you should not use G0289 (Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage [chondro- plasty] at the time of other surgical knee arthroscopy in a different compartment of the same knee) for the situation you describe. Here's why: Medicare created G0289 "to permit appropriate reporting of arthroscopic procedures performed in different compartments of the same knee during the same operative session," the transmittal states. Bonus tip: The same transmittal states that you should report G0289 once per extra compartment, "even if chondroplasty, loose body removal, and foreign body removal are all performed." This wording suggests that you may report G0289 if the surgeon performs one, two or three of the procedures in a separate compartment. CMS also suggested 15 minutes in the additional compartment as a guideline "to ensure that this add-on code is used only when the procedure performed is a substantive procedure needed to produce a significant improvement in the patient's condition," according to the Nov. 7, 2003, Federal Register, page 63232.