Wiki Knee Scope - Multi Procedures in All 3 Compartments

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broncsrox

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I am having a disagreement with my biller so rather than assume I'm right I will post this question....

Unless things have changed very recently that I'm not aware of scope procedures done in separate compartments than the primary procedure are separately reimburseable even by Medicare. Is this still true? My biller is convinced that because CCI shows a 0 under the modifier allowed column we cannot be reimbursed separately.

The scenario is this: medial meniscectomy and chondroplasties in both the lateral and patellofemoral compartments. I coded 29881, 29877-59, 29877-59.

Any thoughts or resources would be appreciated. Thank you!
 
broncsrox said:
I am having a disagreement with my biller so rather than assume I'm right I will post this question....

Unless things have changed very recently that I'm not aware of scope procedures done in separate compartments than the primary procedure are separately reimburseable even by Medicare. Is this still true? My biller is convinced that because CCI shows a 0 under the modifier allowed column we cannot be reimbursed separately.

The scenario is this: medial meniscectomy and chondroplasties in both the lateral and patellofemoral compartments. I coded 29881, 29877-59, 29877-59.

Any thoughts or resources would be appreciated. Thank you!
Click to expand...

It can be a bit trickier for non-Medicare patients. Many third-party carriers are adopting the G code and requiring its use (instead of 29877) in reporting chondroplasties performed concurrent with other arthroscopic knee procedures. Carriers should understand that the G code can be reported more than once, provided each mention is for a separate compartment. However, code 29877 can be reported only once, regardless of how many compartments are affected.

http://www2.aaos.org/aaos/archives/bulletin/apr05/code.asp
 
Hello

PER CPT ASST.
Year: 2001

Issue: August

Pages: 5

Title: Arthroscopic Knee Procedures


"29877Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)

Code 29877 describes smoothing of roughened or damaged cartilage surrounding one or more of the articular ends of the bones in the knee joint by debridement or shaving. This code should be reported only one time, regardless of how many areas are debrided or shaved."


Commerical Carriers (not following CCI)
29881
29877-59 (can only bill once)

CMS
29881
G0289 per compartment

Hope this helps!!!!!!!!
 
I believe that will help. Thank you to both of you. I will have my biller run the G code through to see if that's what they require. We're dealing with BCBS which is always a challenge.
 
Ive come across this scenerio a few times and BCBS pays
29881
G0289
G0289/59

Only one procedure per compartment can be billed and they do get paid :)
 
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