Orthopedic Coding Alert

Question: We bill for an orthopedic surgeon who frequently codes 29880, G0289, 29874, and 29875. Can we report 29874 with 29880?

Alabama Subscriber

Answer: For Medicare and commercial payers who have adopted 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), you cannot code 29874 (Arthroscopy, knee, surgical; for removal of loose body or foreign body [e.g., osteochondritis dissecans fragmentation, chondral fragmentation]) since it's bundled within the codes 29880 (Arthroscopy, knee, surgical; with meniscectomy [medial AND lateral, including any meniscal shaving] including debridement/shaving of articular cartilage [chondroplasty], same or separate compartment[s], when performed) and 29875 (Arthroscopy, knee, surgical; synovectomy, limited [eg, plica or shelf resection] [separate procedure]).

You cannot report either code if the loose body removal or limited synovectomy was performed in the medial or lateral compartments as this would be inclusive to 29880.

Due to CCI edits, you can only report code 29875 -59 in addition to 29880 when your surgeon does limited synovectomy or plica excision in the PF compartment. If you do not use the modifier, the payer will reject payment for 29875, and only pay for 29880.