CCI eases edits on G0289 to allow billing for loose bodies with meniscectomy
by: Laura Evans
Published Jul 26, 2012
Good news: Starting Oct. 1 this year, you'll be able to get paid again for G0289 when you bill it for loose body removal done in a separate knee compartment with either of the arthroscopic meniscectomy codes, 29880 and 29881.
Officials at Correct Coding Solutions LLC, the CMS contractor that administers the National Correct Coding Initiative (CCI), announced the change in a letter obtained by OCPS.
CCI 18.3, which contractors will begin to use on Oct. 1, will change the modifier indicator to “1” to allow you to append a 59modifier to G0289 when billed with 29880 or 29881. Note that this policy applies only when loose bodies are removed from a separate compartment, CCS officials state. Do not unbundle the code pair when the service is chondroplasty.
The change will be retroactive to Jan. 1, so you'll be able to rebill denied claims for those services or hold claims for loose bodies removal until CCI implements the change, says OCPS technical advisor Margie Scalley Vaught, CPC, CPC-H, CCS-P, ACS-EM, ACS-OR.
Ortho practices have had trouble getting paid by Medicare for loose body removal since the beginning of this year when CPT revised codes 29880 and 29881 to include chondroplasty (29877), even when performed in a separate knee compartment. CCI 18.0 in January extended that rule to prevent separate billing of G0289 with both 29880 and 29881.
That's because G0289 includes both removal of loose bodies and chondroplasty (Full description: “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”).
Even with the new CCI edits, some practices continued to bill G0289 with 29880 and 29881, in spite of the automatic denials.
“We actually took the stance that we would try to bill G0289 for loose bodies if documented in a separate compartment, then appeal,” says Ruby O'Brochta Woodward, BSN, CPC, CCS-P, COSC, ACS-OR, compliance and research specialist at Twin Cities (Minn.) Orthopedics P.A.
The CCI Policy Manual supports separate payment for loose bodies, she points out.
Practices will need to be careful not to bill G0289 for separate chondroplasty, which remains bundled, according to both CPT and CCI coding rules.
Tip: When selecting codes for your arthroscopic meniscectomies, ask yourself:
1.Did the orthopedist document removal of loose bodies? (If so, go to Question 2.)
2.Were the loose bodies removed from a separate compartment from the meniscectomy procedure(s)? (If so, G0289 may be warranted.)
3.Did the physician do a chondroplasty in a separate compartment? (If yes, you still may not report G0289 unless loose body removal was also performed.)
Woodward notes that at her practice, “the number of G0289s for loose bodies has decreased with the reminder that it reads ‘separate compartment' and nothing else.”
