Wiki Knee coders please help!

[kandekane8]

Hello fellow coders,

Could someone please help me with this surgery?

The doctor had 29873 (arthroscopic lateral release) and 27422 (open medial patella femoral ligament reconstruction. Also a autograft hamstring harvest requiring separate incision and additional 15 minutes.

27422-22 was what was coded (22 for separate hamstring incision)

The doc feels that both procedures should be billed. I told him the 29873 is bundled into the 27422. Opinions? Or help me explain why?

Thanks in advance!

Heather

 

[dclark7]

Read the NCCI Edits General Policies Manual, chapter 4 (page IV-6 refers to arthroscopy with open procedure), and see if that helps to explain things to your physician. http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html

(Scroll to the bottom of the page in the above link and you'll find the policy manual.

 

[mray85]

I agree with dclark7. CCI edits have indicator 1. Global service package data shows that a retinacular release is included in 27422.