Orthopedic Coding Alert

 Use this template to show the payer why you deserve reimbursement

Although Medicare introduced G0289 over a year ago, some carriers are still stubborn when it comes to reimbursing orthopedists for separate compartment chondroplasties with meniscectomies. If your insurer sends you a denial, send them a copy of the following appeal letter.

We've laid out this template, courtesy of Denise Palmer, coder at CGH Billing in Louisville, Ky., for you to adapt to your practice's specific circumstances.

Note: See our article "Know Your Knee Compartments to Select Arthroscopy Code" for more information on when you can report separate compartment chondroplasty with meniscectomy.

July 10, 2005

Smith Insurance Co.
100 Elm Street
Anytown, USA 10000

RE: Denial for Separate Compartment Chondroplasty With Meniscectomy
Insured: Raymond Johnson
Patient: Sally Johnson
ID #: 12345-6789
Date of service: March 15, 2005
Claim #: MR600450

Dear (Medical Director's Name):

This letter is to appeal your denial of payment for the attached claim.

You denied our claim for medial meniscectomy with lateral chondroplasty by erroneously bundling CPT code G0289 into 29881 and allowing no payment for G0289.

However, CPT coding guidelines do allow for a separate charge in this instance. We have confirmed this with the National Correct Coding Initiative, version 11.2, and consulted CPT Coding Guidelines as provided by the American Medical Association.

Attached you will find a copy of the Nov. 7, 2003, Federal Register, which indicates that CMS created G0289 specifically "to permit appropriate reporting of arthroscopic procedures performed in different compartments of the same knee during the same operative session."

Enclosed you will also find my operative report, indicating that I performed the chondroplasty in the lateral compartment and the meniscectomy in the medial compartment. Based on this information, we expect to receive additional payment for our claim.

If you have any questions or would like to discuss this further, please call me at (555) 555-1234.

Thank you for your immediate attention to this matter. I will look for your reply within 14 days.
Sincerely,

John Doe, M.D.