Wiki PractiCode Does 29875 include a chondroplasty?

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snwhite0730

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Hello Coders,

I am working my way through PractiCode and I just need a better understanding of why I got this wrong. I coded for both the plica excision and the chondroplasty. PractiCode only coded for the plica excision?

I'm not sure how it works with posting the exact case from Practicode with copyright or whatever so I will just post what made me think this was two separate procedures:

NAME OF PROCEDURE: Right knee examination under anesthesia, arthroscopy, medial plica excision, and medial femoral condyle chondroplasty.

We therefore went ahead with excision of the plica and a chondroplasty.

Procedure Rationale:
CPT Rationale: The procedure performed was an arthroscopic excision of the medial plica.

I put the codes in the RVU calculator and listed 29877 as the first procedure and 29875 second with a 51 modifier. I got 4/5 with my first code being wrong and no credit given for the other code. The rationale only lists the synovectomy and not the chondroplasty, but I don't understand why? 29875 has a note that it is a separate procedure and 29877 is for the chondroplasty. If anything, in my thinking, 29877 would include 29875 and not the other way around? What am I missing?

I know this isn't a PractiCode-specific forum but my hope is to get clarity from coders who may know about NCCI edits or guidelines that I am not familiar with that makes this make more sense? Or if I just got it wrong because I misunderstood the services included in the code, that is fine too. I just need to understand what I did wrong for this. Thank you to my fellow Coders for any enlightenment!
 
You need to check the NCCI edits, not the RVU calculator. These two codes hit an edit and 29875 is the primary code between these two. So code 29875 would be reported.
 
Thank you SO MUCH! I did a search of the NCCI edit for 29875 and found exactly what you stated. Now it makes sense. They should put the NCCI edits in the rationale but that is not the issue at hand. Thank you, True Blue for the clarity. I will never forget this edit now and I now to use the NCCI edit tool when coding. I will go back to some of the other cases I got wrong and see if they too fell under an Edit. I appreciate your reply and helping me become a better coder!
 
snwhite0730 said:
Thank you SO MUCH! I did a search of the NCCI edit for 29875 and found exactly what you stated. Now it makes sense. They should put the NCCI edits in the rationale but that is not the issue at hand. Thank you, True Blue for the clarity. I will never forget this edit now and I now to use the NCCI edit tool when coding. I will go back to some of the other cases I got wrong and see if they too fell under an Edit. I appreciate your reply and helping me become a better coder!
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That's the easy part. Try telling a surgeon who has performed two procedures that it's correct to only submit one procedure to insurance.
 
Orthocoderpgu said:
That's the easy part. Try telling a surgeon who has performed two procedures that it's correct to only submit one procedure to insurance.
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Not looking forward to that part of the job. thankfully have a healthcare background and found a job right after I passed my CPC. I'm hoping to build good relationships with the providers but having worked with doctors in the past I know there are some who don't like being second-guessed.
 
While I understand the rationale under NCCI, I disagree from a real-world coding perspective. In the real world I would report 29877 instead because it has a higher RVU. Your thinking was also correct that 29875 has separate procedure designation and separate procedures are usually components of more complex services and not identified separately. From the info above, the provider performed both procedures, I would code 29877.
 
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