Wiki 29881 w/ 29875 - Need Advice

[cclarson]

I have always been trained to code 29881 with 29875-59 whenever plica was excised (plica syndrome). I was told I could code 29875 with the 59 modifier as it warrants a more extensive procedure, as is allowed per NCCI edits of the American Medical Association. However, Medicare is coming back and recouping previous surgeries where this has been done, despite all supporting documentation sent to them. I've done some research and I've seen articles that state that the two codes should never be coded together, even if 29875 is done in a separate compartment. So what should I do, NCCI edits says it's possible to code them together, while other research says otherwise. Any thoughts? Any documentation/support for whether they should be coded together or separately? Thank you.

 

[Orthocoderpgu]

Code 29875 should never be billed with other procedures. It's listed in the CPT book as a "Separate Procedure" meaning that unless performed on its own (basically speaking) it would be bundled. Since at least 2017 the CMS NCCI Surgical Policy Manual has stated that code 29875 cannot be billed with any other arthroscopic code. I'm shocked that Medicare even made payment.

 

[cclarson]

Code 29875 should never be billed with other procedures. It's listed in the CPT book as a "Separate Procedure" meaning that unless performed on its own (basically speaking) it would be bundled. Since at least 2017 the CMS NCCI Surgical Policy Manual has stated that code 29875 cannot be billed with any other arthroscopic code. I'm shocked that Medicare even made payment.

Well, per current NCCI edits, it says 29875 is codable (1 - allowed) with 29881, with the use of a modifier if it's considered an "extensive procedure". I'm wondering what they see as an extensive procedure? or are they saying that 29875 can only be coded together if it's the other knee?

 

[Orthocoderpgu]

Again. Code 29875 is listed as a "Separate Procedure" and the CMS NCCI Surgical Policy Manual specifically states 29875 cannot be billed with any other arthroscopic code. The "1" in the edits just means that it is possible to bill these codes together. Almost every edit is listed this way. In this case the procedures could be performed on opposite knees, hence the reason for allowing both codes. There are very few edits that state the codes cannot be billed together, because most of the time the procedures can be performed on opposite sides. If the codes hit an edit, the question that you need to answer is do the procedures "Qualify" for a modifier -59? In this case the answer is clearly no.

 

[cclarson]

Again. Code 29875 is listed as a "Separate Procedure" and the CMS NCCI Surgical Policy Manual specifically states 29875 cannot be billed with any other arthroscopic code. The "1" in the edits just means that it is possible to bill these codes together. Almost every edit is listed this way. In this case the procedures could be performed on opposite knees, hence the reason for allowing both codes. There are very few edits that state the codes cannot be billed together, because most of the time the procedures can be performed on opposite sides. If the codes hit an edit, the question that you need to answer is do the procedures "Qualify" for a modifier -59? In this case the answer is clearly no.

Thank you for the information as always.

 

[Simone88]

With Medicare you can not submit two procedures because only one is allowed per day so report the higher paying procedure. 29881 would be the more expensive procedure. You can use 59 modifier with other procedures that are not billed with Medicare insurance. Always include the RT or LT modifier according to which side was operated on.