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LTibbetts

LTibbetts

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I am trying to gather as much info and resources as I can for chondroplasty coding along with a menisectomy. A person in another department who is not a certified coder, but is allowed to code the physician side of the surgical charts that I do, has come to me stating that she does not agree with my code selection and refuses to add the charge on her end. There was a torn lateral meniscus that was repaired along with a chondroplasty done in the lateral compartment. This is clearly documented in the op note. She is claiming that I can't code the 29877 because it is included in the 29881 and that even if I did, I would have to use a -51 modifier. I was pretty taken aback by this, especially since she is not even a certified coder.
Anyway, I have done quite a bit of research on this issue myself and I am pretty sure that I am ok to bill the 29881, 29877-59 together. I need to find proof that I can show to my supervisor stating that this is appropriate for coding this chart. I have an article from the AAOS archives and I can find stuff on the CMS website but it mostly pertains to their G code and I am not sure that it will be helpful enough to my supervisor because I know that you can use the G code more than once but only use the 29877 code one time and I don't want to confuse her more as she is also not a certified coder. Please help. Can anyone tell me of any other resources on this matter to support my selection of codes and if there is anyone who does not agree with me, please let me know why as I thought I was right with this.
 
Leslie the 29877 is bundled with the 29881 and the 29880 and is nonmodifiable. I have coded numerous ortho claims and I have found that most if not all carries do follow this edit. I had several docs that instructed that they wanted the 29877 code used and not the G0298 only to find that the payer paid the one with the lowest RVU value. Also something I discovered in a couple of different states and different payers.. even though they had both the 29877 and the G0289 in their fee schedule, the G code had a higher reimbursement value. So the upshot of al of this is, the 29877 is bundled and it matters not that your documentation can support separate area, it is non modifiable, so use the G code.
 
Hi Deb,
thanks so much for your input. If the payer is Cigna, should I still use the G code? Does that mean that if I use the G code then it can be unbundled? Sorry but I am really confused now.
 
For carriers not following CCI here is what CPT Assistant Coding Consultation: Q&A April 2005 has to say:

Musculoskeletal System/Surgery

Question: If debridement or shaving of articular cartilage and meniscectomy are performed in the same compartment of the knee, can codes 29881 and 29877 be reported together?

AMA Comment:From a CPT coding perspective, if debridement or shaving of articular cartilage and meniscectomy are performed in the same compartment of the knee, then only code 29881, Arthroscopy, knee, surgical; with meniscectomy (medial or lateral, including any meniscal shaving), should be reported. However, if debridement or shaving of articular cartilage is performed in one compartment of the knee and a meniscectomy is performed in a different compartment of the knee, then codes 29877, Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty), and 29881 should be reported. Modifier 59, Distinct procedural service, should be appended to the secondary procedure to indicate that the procedure was performed in a different site (ie, different compartment of the knee) than the first procedure.

AAOS GSD guidelines do not include 29877 in 29881 or 29880 if done in a separate compartment.

Your insurance contracts may have something to say about these pairings, too, as well as using 29877 versus G0289.
 
I know that the AAOS does not consider these to be bundled and this has been a hotbed issue for years. But the short story is most carriers do follow CCI edits and will bundle these. Interesting note - a payer in California, the office insisted on billing with the 29877 and it did pay for several years and then suddenly they stopped and denied as bundled, then they review all the cases they had paid, they requested enormous refunds for all the 29877 items paid over the years as the contract stated they followed CCI edits. Sooooo Leslie, yes the G0289 will not bundle it is Chondroplast in separate compartment, I have never used a modifier. When in doubt look at the carriers fee schedule.
 
Short answer is if it is the same compartment you cannot bill both if in separete compartments you can. For instance if you did a lateral menisectomy and a patellofemoral chondroplasty you can code for both but if you do a lateral menisectomy and a lateral chondroplasty you only code the menisectomy the chondroplasty is included. This is from the the Orthopedic Praticum for the Exam Prep for the COSC. (CPT coding for Orthopaedics from AAPC) Hope this helps.
 
mitchellde said:
I know that the AAOS does not consider these to be bundled and this has been a hotbed issue for years. But the short story is most carriers do follow CCI edits and will bundle these. Interesting note - a payer in California, the office insisted on billing with the 29877 and it did pay for several years and then suddenly they stopped and denied as bundled, then they review all the cases they had paid, they requested enormous refunds for all the 29877 items paid over the years as the contract stated they followed CCI edits. Sooooo Leslie, yes the G0289 will not bundle it is Chondroplast in separate compartment, I have never used a modifier. When in doubt look at the carriers fee schedule.
Click to expand...

Thanks again, Deb. I certainly don't want to go through all of that! Since my last post, the other coder/biller has said to me that she went to the Cigna homepage and she states that Cigna does follow the edits and will not pay for 29877. So I know I sound like a broken record, but does that mean that I can still use the G code for this account or not?
 
LOL sorry! I just wanted to get it all out there... So I went back and read your original post, you state lateral meniscectomy and a lateral chonroplasty, so no you may bill only the 29881 in this instance.
For the future if you have a lateral meniscectomy and a medial chrondroplasty THEN you will use the 29881 with a G0289
sorry for the long way home there!
 
mitchellde said:
LOL sorry! I just wanted to get it all out there... So I went back and read your original post, you state lateral meniscectomy and a lateral chonroplasty, so no you may bill only the 29881 in this instance.
For the future if you have a lateral meniscectomy and a medial chrondroplasty THEN you will use the 29881 with a G0289
sorry for the long way home there!
Click to expand...


I'm sorry, too, Deb, because I did mean that the patient had a medial menisectomy and the debridement was in the lateral compartment. Boy, I have had a long day! So the the G0298 would apply? I really appreciate your time with all of this!
 
Me again, I just got off the phone with Cigna (which, I guess, is what I should've done in the first place) and they claim that they do not cover the G code either. Man, I really hate being wrong, you know? Now, if you'll excuse me, I have to go eat crow....
Thanks for your help!
 
Say what?? If they follow CCI edits then they should at least accept the G code, I have had this paid by Cigna before. Ok so you have two choices here.
First you know CCI edits consider this bundled and non modifiable.
So for commercial you can either try
29881
29877 59
Which quite honestly very rarely works
or
29881
G0289
Now I know you said they say they do not accept the G code but how reliable is this information, do you have access to the fee schedule? The reason I bring this up is lets suppose they really do not then what happens is you do run the risk of being paid the lower RVU of the 29877/G0289 or the 29881.
Do not worry I am not busy today, My seminar was cancelled due to weather so I am just hanging out in a hotel in Philly!
 
Well, that's what I thought, too. I thought that at least the G code would be recognized if not the 29887-59. I figured that maybe Cigna was the exception to this rule. I have been using the codes that you suggest above for a while now and have not had a problem up until now. Even CMS covers the G code for crying out loud. I don't know what to make of what you said about "how reliable is the source". I just called cigna from home last night and was told that info by the rep. Do you think that maybe there is a chance that they made a mistake or misunderstood my question? To be honest, I was really surprised by it too because after that, I called 2 other payers and both of them (and CMS, too) would accept the code. We have 2 consultants here today to audit some of our charts, so I think that I will have them take a look at it and see what they have to say. Enjoy your room service!
 
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