Wiki Question regarding change to 29881

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fhysong

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When a code has been revised and the definition of the code changes effective as of 01/01/2012 do most of you follow the old definition until denials are received or do you go by the new definition effective date? The physician wants to still bill a chondroplasty performed in a different comparment during the same surgical session. Previously submitted as 29881, 29877-59 for 2011. I don't think I should be billing this way for 2012 because of the definition change. The CCI edits that are alreay in place only allowed this pulled out if it was done in a separate compartment 2011. The change in the definition has bundled the code itself. Your thoughts are greatly appreciated.

thanks
 
The change is effective on January 1st. Any procedures performed prior to January 1st should be coded and paid under the old definition and procedures performed after Jaunaury 1st coded using the new CPT definition.
 
Mel

Can you tell me if synovial debridement would also be considered as included in 29881 or 29880? If not, would modifier 22 be appropriate to use to indicate additional work in the surgery?
 
@ mlangford, if your doc is doing an actual "Synovectomy" then you would use the 29875 with -59 mod (assuming it's done in separate compartment of the knee, as opposed to where Meniscetomy is being performed (since 29875 is bundled to 29881).

But if it's an actual Debridement, it doesn't matter what compartment of the knee the doc is in, as of 2012 that Debridement (chondroplasty code) is BUNDLED to the 29880 & 29881 codes!
 
Thanks so much! The physician did not say "synovectomy" just debridement of synovitis at the same time as chondroplasty of the patella, which of course is now bundled into 29881/29880. I appreciate the assistance.
 
I have not run across anything written for MC on the chondroplasty altho I use Endcoder for
a resource in bundling. When I entered 29870 w/ G0289 endcoder stated not allowed and modifier not allowed.

As for other payers it is now bundled in with the 29880 or 29881 even tho it would be in separate compartment.

If anyone has anything from MC on this could you let me know?

Thanks
Marsha
 
When I read the new revisions for chondroplasties I was suprised there wasn't any previous mention of this revision, the doctor's were surprised too, I thought, did I miss something, this seems pretty big to Orthopedics, is the AMA in favor of this new ruling.
And I agree any compartment now excludes use of G0289.
 
The AMA is the organization that creates and produces the CPT codes so yes they are in favor of this. As far as advance notice you get the notice when you get the new book for the year which you should get somewhere in November or December. Also the AMA has a book that you can purchase called CPT changes which comes out every year. This book explains this change and the rationale behind it. Or you can attend the seminar the AMA puts on in Novemebr of every year to explain the new changes effective for the next year.
The point is this information is available prior to the effective date, however it is rarely available free and to get it timely you need to plan the purchase of your books so that they arrive prior to January 1.
 
AAOS AMA Agreeing with Modifier Change More Info Request

orthobiller2000 said:
this seems pretty big to Orthopedics, is the AMA in favor of this new ruling.
.
Click to expand...
Debra, a follow up to your response that AMA is in favor of this. Are you saying that AMA supported the modifier indicator change done by CMS? I cannot find any AAOS discussion on this change. While AMA finalizes and published CPT codes, they are not in charge of CCI edits which are authorized by CMS and published by NTIS.

Usually, when edits are changed, CMS sends an email to any affected specialty society notifying them of the intended change and allowing them 90 days to comment/challenge the change. I cannot locate any discussion that occurred on the change in 29880 and G0298’s modifier indicator from 1 (allowed) to 0. Sometimes, the email goes to the wrong recipient (for instance, that employee is no longer in that position) or sometimes it just goes unnoticed due to increased workloads from reduced budgets or employee turnover.

The modifier indicator change effective with CCI 18.0, effective Jan. 1 2012 contradicts the updated 2012 CCI policy manual – Chapter 4 -Bullet #10 which states:

10. CPT codes 29874 (Surgical knee arthroscopy for removal of loose body or foreign body)
and 29877 (Surgical knee arthroscopy for debridement/shaving of articular cartilage) should
not be reported with other knee arthroscopy codes (29866-29889). HCPCS code G0289 (Surgical
knee arthroscopy for removal of loose body, foreign body, debridement/shaving of articular
cartilage at the time of other surgical knee arthroscopy in a different compartment of the same knee)
may be reported.

I am contacting AAOS to see if they were aware of the modifier indicator change and the still existing manual entry. I will also contact some contractor medical directors and raise this issue. I have taken these actions with two questionable modifier changes in the past that eventually led to two reversals of such “surprise” modifier indicator changes – one affecting pediatrics and one affecting ENT.

Do you, however, have inside information that AAOS was notified of the intended change by CMS and supported/challenged it -- and it was ultimately accepted?

Thank you for any further information you can share.

Sincerely,
Jennifer Godreau, BA, CPC, CPMA, CPEDC
Director of Development & Operations, SuperCoder.com, The Coding Institute, LLC jenniferg@codinginstitute.com
 
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Jennifer Godreau said:
Debra, a follow up to your response that AMA is in favor of this. Are you saying that AMA supported the modifier indicator change done by CMS? I cannot find any AAOS discussion on this change. While AMA finalizes and published CPT codes, they are not in charge of CCI edits which are authorized by CMS and published by NTIS.

Usually, when edits are changed, CMS sends an email to any affected specialty society notifying them of the intended change and allowing them 90 days to comment/challenge the change. I cannot locate any discussion that occurred on the change in 29880 and G0298’s modifier indicator from 1 (allowed) to 0. Sometimes, the email goes to the wrong recipient (for instance, that employee is no longer in that position) or sometimes it just goes unnoticed due to increased workloads from reduced budgets or employee turnover.

The modifier indicator change effective with CCI 18.0, effective Jan. 1 2012 contradicts the updated 2012 CCI policy manual – Chapter 4 -Bullet #10 which states:

10. CPT codes 29874 (Surgical knee arthroscopy for removal of loose body or foreign body)
and 29877 (Surgical knee arthroscopy for debridement/shaving of articular cartilage) should
not be reported with other knee arthroscopy codes (29866-29889). HCPCS code G0289 (Surgical
knee arthroscopy for removal of loose body, foreign body, debridement/shaving of articular
cartilage at the time of other surgical knee arthroscopy in a different compartment of the same knee)
may be reported.

I am contacting AAOS to see if they were aware of the modifier indicator change and the still existing manual entry. I will also contact some contractor medical directors and raise this issue. I have taken these actions with two questionable modifier changes in the past that eventually led to two reversals of such “surprise” modifier indicator changes – one affecting pediatrics and one affecting ENT.

Do you, however, have inside information that AAOS was notified of the intended change by CMS and supported/challenged it -- and it was ultimately accepted?

Thank you for any further information you can share.

Sincerely,
Jennifer Godreau, BA, CPC, CPMA, CPEDC
Director of Development & Operations, SuperCoder.com, The Coding Institute, LLC jenniferg@codinginstitute.com
Click to expand...

What I am saying is the AMA creats the CPT codes and the rational for the change to the 29880 and 29881 was because they have data that supports that more than 75% of the time when a 29880 or 29881 is performed, the physician also performs the equivalent ofthe 29877, so they combined the descriptors together in one code. They did this with several code combination that met this same test. It had nothing to do with CCI edits it is that the code descriptor has changed and the chondroplasty is now an inclusive component of the 29880 and 29881, read the 2012 descriptors. With this change you can no longer code the G 0289 with these codes
 
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