Wiki G0289

[adunlap23]

Does anyone have updated guideline on billing G0289 with 29881/29880? This was a big thing last year, but everything I read seems to have differing opinions on when it's appropriate to bill the codes together.
I once heard the loose body has to be 5mm or bigger in order to report G0259 but can't seem to find that information anywhere. Any insight would be helpful.

Thank you.

 

[Orthocoderpgu]

Does anyone have updated guideline on billing G0289 with 29881/29880? This was a big thing last year, but everything I read seems to have differing opinions on when it's appropriate to bill the codes together.
I once heard the loose body has to be 5mm or bigger in order to report G0259 but can't seem to find that information anywhere. Any insight would be helpful.

Thank you.

Your "crossing" coding guidelines. The 5mm is a guideline from AAOS. G0259 is a code that per CMS can be used under very limited circumstances to show that a loose body or debridement was performed in a separate compartment. CMS has never had the 5mm rule in their policy to support G0289. When your coding surgeries you have to know what insurance you are dealing with. Most insurance companies follow CMS but will include coding guidelines from AAOS and others to cover specific circumstances. CMS meant for G0259 to be used when billing them, but private payers can decide to include the code as well. Don't think that just because AAOS made a guideline that CMS is going to follow it, or vise versa. If you have EncoderPro you can go to the coding tips which state that the loose body is only reported when the body is the same size as the arthroscope being used so the scope must be switched out for a larger ones or another portal must be created or its taken through an incision. I almost never see these conditions being met.

 

[adunlap23]

Your "crossing" coding guidelines. The 5mm is a guideline from AAOS. G0259 is a code that per CMS can be used under very limited circumstances to show that a loose body or debridement was performed in a separate compartment. CMS has never had the 5mm rule in their policy to support G0289. When your coding surgeries you have to know what insurance you are dealing with. Most insurance companies follow CMS but will include coding guidelines from AAOS and others to cover specific circumstances. CMS meant for G0259 to be used when billing them, but private payers can decide to include the code as well. Don't think that just because AAOS made a guideline that CMS is going to follow it, or vise versa. If you have EncoderPro you can go to the coding tips which state that the loose body is only reported when the body is the same size as the arthroscope being used so the scope must be switched out for a larger ones or another portal must be created or its taken through an incision. I almost never see these conditions being met.

Thank you for your reply. I do not have EncoderPro. I only have Codify through AAPC. The payer in this situation is Medicare Novitas Solutions.

 

[amyjph]

I agree with the advice above and also that it is highly unlikley to never that the condition to be able to report it is met. I have done it maybe twice that I can think of, ever. Not saying it can't happen, it's just extremely rare.

See NCCI manual: https://www.cms.gov/files/document/medicare-ncci-policy-manual-2023-chapter-4.pdf
6. CPT codes 29874 (Arthroscopy, knee, surgical; for removal of loose body or foreign body (eg, osteochondritis dissecans fragmentation, chondral fragmentation) and 29877 (Arthroscopy, knee, surgical; for debridement/shaving of articular cartilage (chondroplasty) shall not be reported with other knee arthroscopy codes (29866-29889). With 2 exceptions, HCPCS 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) may be reported with other knee arthroscopy codes. Since CPT codes 29880 (Arthroscopy, knee, surgical; with meniscectomy(medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty) same or separate compartment(s), when performed and 29881 (Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty) same or separate compartment(s), when performed include debridement/shaving of articular cartilage of any compartment, HCPCS code G0289 may be reported with CPT codes 29880 or 29881 only if reported for removal of a loose body or foreign body from a different compartment of the same knee. HCPCS code G0289 shall not be reported for removal of a loose body or foreign body or debridement/shaving of articular cartilage from the same compartment as another knee arthroscopic procedure.

To report it you would have to have say, a medical meniscectomy (29881) and then they would have to go into the lateral compartment (for example) and remove a LB and it has to be at least the same size or greater as the diameter of the cannula (among other requirements as stated above). It's really rare to see this.