Wiki Knee scope with med and lat menisectomy

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scsmyers

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I have a Knee scope with medial and lateral menisectomy coded as 29880, but I also have Patellar chondroplasty, medial femoral condyle Chondroplasty as 29877, I am being told these are comprehensive/component code pair and cannot be billed together on the same date of service
How should I code this?

Crystal
 
the 29877 is bundled and non modifiable with 29880 or 29881, it always has been. CMS many years ago created G0289 for chondroplasty in separate compartment. Most commercial carries also accept this code. You need to link it to chondromalacia of the patella assuming this is documented of course, and without this dx most will not pay this code.
 
Since the chondroplasty was done in the pf compartment you can append a 59 modifier to 29877. If you are billing an insurance that accepts G0289 no modifier will be needed. If billing 29877-59 you will need to appeal but it should get paid. :)
 
The CCI edit for the 29877 specifically shows that it is a non modifiable edit. So just adding a 59 will not get it done. I have never had a payer not accept the G0289. Most payers also follow CCI edits, so we should not bill this pair together.
 
It depends on the payor-the big carriers like UHC, Cigna and Anthem will accept the G code however in CO our WC carriers want 29877. You can append a 59 if the carrier does not accept the G code-I'm trying to find addl info but it has been discussed numerous times on other list servs.
 
There is a PDF on the AAOS website stating that you can append 59 to 29877 for private payors. :)
 
I understand what you are saying. However WC is a completely different issue in every state and we should never base how we do things for all other payers on what WC wants. Second if the payer has stated they follow CCI edits then it is wrong for us to try and push this thru with a 59 modifier just because the AAOS says it can be done. The CCI edits exist whether we like it or not and if our payer adheres to them then that is the end.
 
I understand what you are saying however Medicare did put out guidelines when they created the G code which address bypassing the edit.
 
I would love to see the link to that. I do not recall ever seeing anything from Medicare to be able to bypass the CCi edits with a modifier when the edit specifically tells us it is non modifiable. If this were the case then there would be no need to have the edit. The G code was created to use when the chondroplasty is performed in a separate compartment and is therapeutic for the patient. So the G code technically does not bypass the edit. You use it instead of the 29877 when documentation supporst its use.
 
Medicare shows the “0” modifier, it also provides written instructions in the General Policy Section of the Musculoskeletal Section of the CCI edits. Because Medicare does not include HCPCS code G0289 in the list of codes that may be reported in addition to CPT code 29881 some confusion may result.
 
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