Orthopedic Coding Alert

Chondroplasty might be one of the most common knee procedures on your orthopedist's schedule, but that doesn't mean you'll always how to handle the claim -- especially if you're unsure when to report CPT versus HCPCS coders. Read on for the latest on payer preferences and when you can -- or can't -- report each option.

Most coders automatically think of 29877 (Arthroscopy, knee, surgical; debridement/shaving of articular cartilage [chondroplasty]) for chondroplasty procedures, and that is a viable choice. Confusion arises when you bill 29877 with another arthroscopic procedure or when you remember another option in your HCPCS book: G0289 (Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage [chondroplasty] at the time of other surgical knee arthroscopy in a different compartment of the same knee).

"Using 29877 versus G0289 is payer specific," says Denise Paige, CPC-COSC, a coder with Bright Health Physicians of Presbyterian Intercommunity Hospital in Whittier, Cal. "The trick is to know your payers' preferences and know how to turn a denial around."

The knee is divided into three compartments: the medial, lateral, and patellofemoral. Your physician should always specify which compartments he accesses during the procedure because that documentation is key to your coding -- and is vital if you ever need to appeal the claim.

"If the procedures are only mentioned in the title of the report but aren't found (or aren't found easily) in the body of the report, you'll have a hard time appealing the claim," Paige says. Urge your physicians to dictate each compartment as a separate paragraph in their op notes, and ideally, label each paragraph with the name of the compartment.

Tip: "We were taught long ago to separate the compartments into M-L-PF (medial, lateral, or patellofemoral)," says Gloria Moran, practice manager for the university division of Jacksonville Orthopaedic Institute in Jacksonville, Fl. "Jot down what was done in each compartment and code accordingly."

Remember a few things when you prepare to report 29877 or G0289:

Point 1: You can only report 29877 once per operative session, no matter how many compartments the surgeon treats. As Moran says, "You cannot double dip into the same compartment twice."

Point 2: If your surgeon completes 29877 in additionto another arthroscopic procedure (such as 29874, Arthroscopy, knee, surgical; for removal of loose body or foreign body [e.g., osteochondritis dissecans fragmentation, chondral fragmentation), the procedures must be in separate compartments before you can code both. Append modifier 59 (Distinct procedural service) to 29877. "However, it's up to the carrier to pay when billed that way," Paige cautions. "Some payers follow the CCI [Correct Coding Initiative] edits and will deny the claimeven if you use modifier 59. If you appeal using the AAOS guidelines citing separate compartments, they might pay."

Point 3: You can report G0289, however, for each individual compartment if the surgeon does not perform any other procedure in the compartment. "Medicare is specific in not wanting us to bill G0289 for any  procedure done in the same compartment as the main procedure being performed," Moran says. "It's a bit trickier for non-Medicare patients, though many third party payers have adopted the G code and are requiring its use instead of 29877."

Although HCPCS doesn't use the same symbols or notations at CPT, an explanatory note with G0289 directs you to treat it like an add-on code: "Add-on code reported with knee arthroscopy code for major procedure performed -- reported once per extra compartment." Having the G0289 option helps balance things out in some cases since you can only report 29877 once.

"If the payer recognizes G0289 and has adopted the Medicare reporting guidelines associated with this code, you can report it more than once provided it was the only procedure performed in that compartment," explains Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network.

Example 1: Your surgeon completes a medial meniscectomy, lateral meniscectomy, and patellofemoral chondroplasty. Because you're coding procedures in differentcompartments, you can report 29880 (... with meniscectomy [medial AND lateral, including any meniscal shaving) and G0289. The surgeon accessed three compartments, but you need only two codes because 29880 represents both the medial and lateral compartments.

Example 2: Your orthopedist performs a medial meniscectomy, patellofemoral chondroplasty, and excision of a loose body. You'll code 29881 (... with meniscectomy [medial OR lateral], including any meniscal shaving), G0289, and G0289-59. Three codes are appropriate because the meniscectomy was in a single compartment, the chondroplasty was in another compartment, and loose body excision qualifies as an additional procedure.

Once you determine the correct procedure code, double check that you file the appropriate diagnosis:

• Report chondromalacia of the patella with 717.7 (Chondromalacia of patella)

• Report chondromalacia of the medial or lateral knee with 733.92 (Other and unspecified disorders of bone and cartilage; chondromalacia).

Multiples: If you're coding for multiple compartments, include the correct diagnoses. For example, include both 717.7 and 733.92 on the claim for patella and lateral or medial involvement. If the patient has medial and lateral involvement, however, you cannot report 733.92 twice even though the descriptor references "medial or lateral." "ICD-9 codes are reported only once," Stout says.