Wiki Loose bodies removal

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Robbin109

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Pt has tear of medial and lateral meniscus of left knee
along with loose bodies.

MD performs a Medial and Lateral Meniscectomy (29880) and also removes loose bodies from the medial compartment (5mm X6mm) can this also be billed (29874)

Pt has a HMO insurance.

Thanks!!
 
Robbin109 said:
Pt has tear of medial and lateral meniscus of left knee
along with loose bodies.

MD performs a Medial and Lateral Meniscectomy (29880) and also removes loose bodies from the medial compartment (5mm X6mm) can this also be billed (29874)

Pt has a HMO insurance.

Thanks!!
Click to expand...

Just follow this link, it has great information
http://www.aaos.org/news/aaosnow/may10/managing2.asp

code 29874 (Arthroscopy, knee, surgical; for removal of loose body or foreign body [eg, osteochondritis dissecans fragmentation, chondral fragmentation]) may be reported in addition to other arthroscopic knee procedures, including arthroscopic chondroplasty and arthroscopic microfracture, if either of the following requirements are met:

The arthroscopic loose/foreign body was greater than 5 mm or
The loose/foreign body was removed through a separate incision or portal (not through the inflow or outflow portal)

If arthroscopic removal of loose/foreign bodies was the only procedure performed, the size or separate incision guidelines do not apply.
 
npricercm,
It doesn't appear to be a separate incision or portal, it says:

"The medial compartment was noted to be frayed with early degenerative changes. cartilage also had the calcium deposits in it.

There was a tear of hte posterior horn of the medial meniscus that measured 5mm x 6mm in size.

A loose body was grasped with a grasper and removed.

The 4.5 shaver was insertedm, the meniscal tissue trimmed and a large amount of the hypertrophic synovial tissue was clacium within was removed."

(..he went on to shave the lateral meniscus)

I believe the code shoulde just be 29880, but 29874 was also coded with this.

What do you think?

scooter1,
thought G0289 was just for Medicare?

Thanks!
 
Since the loose body was greater than 5mm it could be coded even though it was the same compartment as the meniscectomy?
 
A separate report mentions:

"The lateral compartment was examined. There was a vertical tear in the mid portion of the lateral meniscus. This was trimmed back to a healthy meniscal tissue. Loose body was then retrieved from the lateral compartment, taken out through one of the anteromedial portal."

He doesn't mention the size, but is this a separate a portal? Can this one be coded?
 
Robbin109 said:
A separate report mentions:

"The lateral compartment was examined. There was a vertical tear in the mid portion of the lateral meniscus. This was trimmed back to a healthy meniscal tissue. Loose body was then retrieved from the lateral compartment, taken out through one of the anteromedial portal."

He doesn't mention the size, but is this a separate a portal? Can this one be coded?
Click to expand...

AAOS has stated that if thru separate portal or >5mm it is separately reportable with a 59 modifier. Just be prepared that carriers are bundling (even w/supporting documentation) and some may request G0289 which pays pennies on the dollar. You may find that the amount of time and energy is not worth reporting but I also have and followed the appeal process to show my docs that we did our part before we w/o.
 
So how can I tell if the anteromedial is a separate portal?

Also, it can be the same compartment as other procedure as long as it is at least 5mm?
 
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