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 [...]