Wiki Is this "abuse"?

[twizzle]

For a period of time earlier this year, when billing for a particularly demanding orthopedic group, I took it upon myself to bill 29877 (chondroplasty) rather than 29880 or 29881, when a meniscectomy was performed with a chondroplasty. 29877 pays more.
Would this be considered 'abuse"? I know it's not fraud. I mean, they are doing both procedures but a meniscectomy includes chondroplasty when performed, so am I inappropriately gaining extra revenue when billing this way?
My colleague thinks so (she has coded orthopedics way longer than me) and in the end I just billed the meniscectomy.
In addition, the G0289 code also confuses me. Why create another code, albeit a HCPCS code, to effectively override what CPT says? I know not all payers recognize this G code and I gave up billing it a long time ago because it wasn't getting paid.
This demanding orthopedic group were of the opinion that everything should be billed regardless of bundling issues, and see what sticks.
I look forward to feedback from anyone who bills the 29877 instead of the 29880/1 for the reasons I did, or from anyone who knows if this is inappropriate coding and has documentation to prove it or otherwise.
One other thing. For Workers Comp, one of these orthopedists wanted 29880/1 and 29877 unbundled and billed together. Is that fraudulent?

 

[mitchellde]

For a period of time earlier this year, when billing for a particularly demanding orthopedic group, I took it upon myself to bill 29877 (chondroplasty) rather than 29880 or 29881, when a meniscectomy was performed with a chondroplasty. 29877 pays more.
Would this be considered 'abuse"? I know it's not fraud. I mean, they are doing both procedures but a meniscectomy includes chondroplasty when performed, so am I inappropriately gaining extra revenue when billing this way?
My colleague thinks so (she has coded orthopedics way longer than me) and in the end I just billed the meniscectomy.
In addition, the G0289 code also confuses me. Why create another code, albeit a HCPCS code, to effectively override what CPT says? I know not all payers recognize this G code and I gave up billing it a long time ago because it wasn't getting paid.
This demanding orthopedic group were of the opinion that everything should be billed regardless of bundling issues, and see what sticks.
I look forward to feedback from anyone who bills the 29877 instead of the 29880/1 for the reasons I did, or from anyone who knows if this is inappropriate coding and has documentation to prove it or otherwise.
One other thing. For Workers Comp, one of these orthopedists wanted 29880/1 and 29877 unbundled and billed together. Is that fraudulent?

The 29880/1 codes specifically state they include the meniscectomy when performed, so is it incorrect to code only the 29877? ABSOLUTELY! You cannot down code a claim and especially to obtain additional reimbursement. Nor can you add the 29877 since they added the to the description to include the chondroplasty. It is not just bundling anymore the description of the procedure includes the work for the chondroplasty. Now work comp is a different issue, you need to know what year of CPT they are using to know if that definition applies to them or not.

 

[twizzle]

Is is "abuse"?

I understand where you're coming from. My point really is that they have done a chondroplasty and it makes no sense that a meniscectomy and a chondroplasty is worth less than a chondroplasty alone so why not bill the chondroplasty only? They did do it after all.

With regards to WC, they are not using any coding book, they just want us to bill both procedures regardless. They know both procedures are covered by 29880/1 but want 29877 billed as well.
Thanks for your input anyway. Fortunately I don't have to deal with these particular providers any more except as a stand-in.

i don't feel comfortable with what they want and, even though I like orange, I don't want to wear it every day.