Wiki Coding G0289

[lindas]

I represent a freestanding ASC. Recently I billed Medicare code G0289 for which the doctor performed a Chrondoplasty in the lateral tibial plateau and an excision of a ganglion cyst, using the Dx : 715.00.

Medicare denied the code indicating that the service cannot be billed separately. I was under the impression that, we could bill G0289 as a stand alone code. I know that it will be denied when billed with other codes.

If anyone has feed back on this, it would greatly be appreciated.

Linda Smith, CPC

 

[JMeggett]

Linda ~ Here is a policy I found: 100-04 Claims Processing Manual Section 040
Chapter 14-Amb Surg Ctrs
Subject Ambulatory Surgical Centers - Section 40 - Payment for Ambulatory Surgery

"(Rev. 1514; Issued: 05-23-08; Effective: 01-01-08; Implementation: 06-23-08)
Medicare contractors calculate payment for each separately payable procedure and service based on the lower of 80 percent of actual charges or the ASC payment rate. The charge-to--payment rate comparison occurs at the line-item level.
ASCs should not report separate line-item HCPCS codes or charges for items that are packaged into payment for covered surgical procedures and therefore, are not paid separately (e.g., nonpass-through implantable devices). Instead, it is important that ASCs incorporate charges for packaged services into the charges reported for the separately payable services with which they are provided. Facilities may not be paid appropriately if they unbundle charges and report those charges for packaged codes as separate line-item charges.


Orthopedic Coder's Pink Sheet
Effective Date 09/01/2004
Publish Date September 2004
Subject It's a no go for ASCs trying to bill code G0289
"If you code for an Ambulatory Surgery Center (ASC) you can forget about Medicare paying for a chondroplasty performed with a meniscectomy, reported using code 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).
An official from the Centers for Medicare & Medicaid Services (CMS) offers this explanation, “When procedures are performed in an ASC that aren't on the ASC list then Medicare does not pay. There are some occasions when procedures that are not on the list are performed such as a lesion removal from the eyelid and one from the back of the patient's hand. [While the eyelid lesion would be more complicated], the one on the back of the hand would be a quick thing that is done in the office. Rather than make the patient come in for two visits, the physician removes both at the ASC. We would not pay a facility fee for the lesion removal from the hand because it can be done in the office and does not require an ASC. The physician could bill for the procedure documenting that he had performed it in an ASC and he would receive the higher fee at the non-facility rate.”
This holds true whether you are performing the procedure in an ASC or in an outpatient setting under [Outpatient Prospective Payment System (OPPS)]. As of 2003, CMS also bundled or ‘packaged' G0289 under OPPS and no additional reimbursement is allowed for facilities.
Hope this helps,
Jenna

 

[mitchellde]

If you performed a chondroplasty only you will use the 29877 even to Mcare. The G0289 is a code used with other codes but no longer the 29881 or 29880 as they have had the description of their codes changed to include the chondroplasty. So even the G0289 now has only minimal use.