Orthopedic Coding Alert

New reporting guidelines masked by lack of change in codes, descriptors.

There was a lot to digest in CPT^® 2021. Along with the typical additions, deletions, and revisions, coders had to get used to a new way of reporting office/outpatient evaluation and management (E/M) services.

As if that weren’t enough to wrap your head around, there were also some important clarifications issued to already existing codes that will change the way you use them. The AMA has done just that to a slew of arthroscopy with loose/foreign body removal codes.

Help’s here: We asked Heidi Stout, BA, CPC, COSC, PCS, CCS-P, with Coder on Call, Inc., in Milltown, New Jersey, to help us go inside the numbers with these changes, and she was happy to oblige. Here’s what she had to say.

New/Expanded Opening Must Accompany Loose/Foreign Body Removal Codes

The codes that were affected by the AMA’s guidance are as follows:

• 29819 (Arthroscopy, shoulder, surgical; with removal of loose body or foreign body)
• 29834 (Arthroscopy, elbow, surgical; with removal of loose body or foreign body)
• 29861 (Arthroscopy, hip, surgical; with removal of loose body or foreign body)
• 29874 (Arthroscopy, knee, surgical; for removal of loose body or foreign body (eg, osteochondritis dissecans fragmentation, chondral fragmentation))
• 29894 (Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with removal of loose body or foreign body)
• 29904 (Arthroscopy, subtalar joint, surgical; with removal of loose body or foreign body)

As stated earlier, there have been no surface changes to these codes; the descriptors and code numbers are the same as in 2020. “CPT^® has not revised the descriptions associated with the codes for arthroscopic removal of loose body or foreign body from the shoulder, elbow, hip, knee, ankle, or subtalar joint; [but] the AMA has added an important instructional note to the manual,” explains Stout.

Here’s the AMA’s new guidance: “Arthroscopic removal of loose body(ies) or foreign body(ies) (i.e. 29819, 29834, 29861, 29874, 29894, 29904) may be reported only when the loose body(ies) or foreign body(ies) is equal to or larger than the diameter of the arthroscopic cannula(s) used for the specific procedure, and can only be removed through a cannula larger than that used for the specific procedure or through a separate incision or through a portal that has been enlarged to allow removal of the loose or foreign body(ies).”

What it means: When reporting an arthroscopy with loose/foreign body removal, you can only count the removal if the loose/foreign body couldn’t be removed through the original opening at its original size. If the provider doesn’t make a surgical adjustment to remove the loose/foreign body, you should not use any of the codes listed above.

This is a change from years past, says Stout, who uses the 29874 code to illustrate her point.

“While we are accustomed to reporting removal of a loose or foreign body of the knee in addition to other procedures performed on the same knee when the loose body was removed from a different knee compartment or exceeded 5 mm in size, those rules no longer apply,” Stout explains. “The key to separate reporting now lies with documentation that a larger cannula was used, a portal was enlarged, or a separate incision was necessary to remove the loose or foreign body.”

Documentation Drives Successful Claims

When reporting one of the loose/foreign body removal arthroscopy codes, Stout recommends that you document that the provider:

• “Used a larger arthroscopic cannula than you used for any other procedures performed,
• “Enlarged an arthroscopic portal to facilitate removal of the loose or foreign body, or
• “Created a separate incision in order to removal the loose or foreign body.”

Best bet: Be sure your providers (and all the coders in your department) know about this little-publicized change that could have a big impact on some of your 2021 claims.