Orthopedic Coding Alert

Question: I work for an ASC, and Medicare denies 29877 when it's on a claim with 29880 or 29881. Should I be doing something differently?

Michigan Subscriber

Answer: ASCs should not report packaged procedure G0289. Per CMS, -ASCs should not report separate line item HCPCS codes or charges for procedures, services, drugs, devices or supplies that are packaged into payment for covered surgical procedures and therefore not paid separately- (www.cms.hhs.gov/ASCPayment/downloads/ASC_QAs_03072008.pdf).

You should report 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 Medicare instead of 29877 (Arthroscopy, knee, surgical; debridement/shaving of articular cartilage [chondroplasty]).

Medicare requires that you use G0289 for chondroplasty when the surgeon performs both chondroplasty and meniscectomy in separate compartments on a Medicare patient during the same session. You should report the meniscectomy with one of the following:

- 29880 -- Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving).

- 29881 -- Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving)

Tip: The surgeon should document which compartments he addresses for each.

Don't miss: For ASCs, Medicare packages payment for G0289 into its related procedure, so you won't see separate payment for the procedure. You should still report G0289 because CMS considers performance frequency when it sets the related procedure fee.

Some private payers may also require G0289 with the meniscectomy code, but most accept the meniscectomy code followed by 29877-59 (Distinct procedural service) if they don't follow Correct Coding Initiative edits.

-- Reader Questions and You Be the Coder were reviewed by Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network LLC; and Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C.