Orthopedic Coding Alert

Our experts answer your top-4 knee chondroplasty questions

If you've dreaded coding arthroscopic knee surgery claims ever since CMS introduced code G0289 for separate-compartment chondroplasty, you're not alone. Follow our experts' advice to know when you should report G0289 and when you should stick with 29877.

G0289 Reigns for Medicare

Orthopedic coders were shocked in 2002 when the National Correct Coding Initiative (NCCI) announced it would no longer allow practices to append modifier -59 (Distinct procedural service) to separate-compartment chondroplasty claims (29877, Arthroscopy, knee, surgical; debridement/shaving of articular cartilage [chondroplasty]) when physicians perform the procedure with meniscectomies.
 
Shortly thereafter, CMS advised coders to 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) in place of 29877 for separate-compartment chondroplasty.
 
Although many private payers still prefer that practices report 29877 for chondroplasty, Medicare requires that you bill G0289 instead. The following four questions can show you how to accurately report G0289 each time.

 1. Our surgeon performed a lateral meniscectomy with lateral and medial chondroplasties. Which codes should we report to Medicare?

You should report 29881 (Arthroscopy, knee, surgical; with meniscectomy [medial OR lateral, including any meniscal shaving]) and G0289, says Lisa Caspers, RN, CPC, coding educator at All Saints Healthcare in Racine, Wisc.
 
You can only report one unit of G0289 because Medicare includes the lateral chondroplasty in your charge for the lateral meniscectomy (29881). Code G0289 allows you to collect for your medial chondroplasty.

 2. What percentage of the meniscus must the surgeon remove before we should bill the meniscectomy code instead of the chondroplasty code?

The orthopedic surgeon does not need to document any particular percentage of meniscus removal to report the meniscectomy codes, because the meniscectomy is a completely different procedure from chondroplasty.
 
Op note hint: If the surgeon documents that he cleaned out a meniscal tear with an arthroscopic shaver, he performed a meniscectomy (29880-29881). If he documents that he cleaned out articular cartilage with the shaver, he probably performed chondroplasty instead.
 
"Even though the meniscus is considered 'cartilage,' it is not the same type of cartilage as articular cartilage that is present at the end of bones," says Cindy Thomas, RMA, CPC, appeals specialist at the McBride Clinic, a 24-physician practice in Oklahoma City. "Anytime the physician removes meniscal tissue, it is considered
a meniscectomy."

3. Our orthopedic surgeon performed a medial meniscectomy with lateral and patellar chondroplasties. Which codes should we report?

You should report 29881 (Arthroscopy, knee, surgical; with meniscectomy [medial OR lateral, including any meniscal shaving]) once, followed by two units of 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).
 
Tip: "According to the Federal Register, you can report G0289 once per extra compartment," Caspers says.
"Therefore, you can report two units of G0289 in addition to the compartment where the main procedure was performed."

4. A consultant told us that the physician has to spend 15 minutes performing chondroplasty to warrant billing G0289, but our orthopedic surgeon only spent 10 minutes on it. Can we bill code G0289 anyway? 

When CMS established G0289, it advised practices not to report the code unless the surgeon spent at least 15 minutes performing the separate-compartment chondroplasty. Many orthopedic surgeons complained that they would therefore never bill G0289 because they performed chondroplasty efficiently and quickly enough to complete the service in less than 15 minutes.
 
In the Nov. 7, 2003, Federal Register, however, CMS softened the 15-minute requirement and stated, "This reference to time was intended 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. Documentation supporting this should be reflected in the operative note."
 
Therefore, you should use the 15-minute rule as a guideline, but as long as your surgeon documented a substantive separate-compartment chondroplasty procedure, you should report G0289 regardless of the amount of time he spent on the chondroplasty.