Wiki Incidental findings during scheduled procedure

[gmedlock@gmail.com]

If a patient is scheduled for an arthroscopic medial meniscus repair and during surgery the lateral meniscus is found to have a tear, can you code and bill the repair of both? Considering this is an incidental finding? I understand you can use the lateral meniscus tear as a secondary DX, but can you bill for the CPT code? By chance does any orthopaedic coders have any references to incidental findings that they will share so I can inform my providers?

Thank you

 

[Orthocoderpgu]

Need to bill what is documented

As a coder, you need to bill what is documented. In this case, 29880 if both were treated. The pre-authed code may have been 29881, but it would be incorrect to bill it.

I have worked in orthopedics for several years and the frustrating part is that insurance companies think that an MRI or CT gives the physician perfect vision of internal anatomy which is simply not true. Not every pathological finding will show up on MRI or CT scans due to various reasons.

I'm assuming that meniscectomy was performed in both compartments. If one was repaired, you would bill 29881 & 29882 with a modifier to show that the procedures were performed in separate compartments.

You may need to appeal but medical records will support your codes.