Wiki Chondroplasty done alone or loose bodies? help!

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Kiracodes

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I need help because I am stuck...

I have what appears to be a Chondroplasty done alone and billing is pushing back because it is being denied and said it can't be billed alone.

This is BCBS. I am just going to summarize. Am I missing something or just wrong all together? Should we have gone with 29874 instead?



patellofemoral compartment - grade 4 chondromalacia- debrided with shaver of unstable flaps of cartilage in central ridge and edges. Multiple small bodies of articular cartilage vacuumed out from gutter, suprapatellar notch, and throughout knee. Osteophyte compressing ACL and removed with rongeur and smooth with shaver.

Medial compartment - meniscus has very little change. Unstable folded back cartilage (12-15 mm) debrided. Tibia had some thinning of cartilage.

Lateral compartment - similar finding on lateral femoral condyle, grade 4 chondromalacia. unstable cartilage flaps (roughly 10 mm in weightbearing surface) cleaned up. meniscus had degenerative changes but no significant tears. swept around knee and removed small articular loose bodies.
 
yes, I sent through 29877 and they are telling me that they couldn't get prior auth and that it has not received payment in the past. At least not by itself? Should we put it through and appeal the denial if it does comes in?
 
Some payers do have policies in place for 29877 restricting it to only certain diagnoses. For instance, we have a local payer that will not pay for 29877 with a dx of OA.

You didn't mention what DX you had, I assume chondromalacia, but thought I would mention it just in case. Could be worth checking into.
 
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