Orthopedic Coding Alert
Watch Multiple Scope Rule for 29879 and 29881
Question: My orthopedist performed an arthroscopic medial meniscectomy and chondral pick chondroplasty in the same compartment. Can I charge for both 29879 and 29881? Washington Subscriber Answer: According to the latest Correct Coding Initiative (CCI) edits, version 13.1, you can report 29879 (Arthroscopy, knee, surgical; abrasion arthroplasty [includes chondroplasty where necessary] or multiple drilling or microfracture) and 29881 (- with meniscectomy [medial OR lateral, including any meniscal shaving]) on the same claim without worrying about unbundling. Although you might be in the clear with CCI, the multiple scope rule will affect your reimbursement. Both 29879 and 29881 have the same parent code, 29870 (Arthroscopy, knee, diagnostic, with or without synovial biopsy [separate procedure]). Consequently, you-ll face a fee reduction for the multiple scopes from the same code family. Under the multiple scope rule, carriers generally pay the entire fee schedule amount only for the highest-valued endoscopy in a given code family during the same operative session. Insurers then reimburse any additional endoscopies in the same family by subtracting the value of the base endoscopy from the lesser-valued scope and paying the difference. So in this case, the carrier will likely reimburse 29879 at the full relative value (8.84 relative value units according to the national Medicare physician fee schedule) because it is the more extensive procedure. Then it will pay 29881 at 3.45 RVUs (8.56 RVUs for 29881 minus 5.11 RVUs for 29871), for a total of 12.29 RVUs or about $465 nationally. Here's why: The payer has already reimbursed you once for the value of the family base code (29870) when it paid you for the 29879. The carrier doesn't wish to reimburse for this work again when paying you for a same-session 29881. Payer watch: Keep in mind that many carriers have their own rules, and some may not pay for multiple procedures in the same compartment. So review your payers- rules before submitting your claim.
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