29877 and 29873

VIOLYNPLA2

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Would anyone know if a chondroplasty 29877 is bundled with a lateral release
29873. I've checked 2 resources ( code x and coding companion), one does not state that they are bundled and the other does.

Thanks
 

dmaec

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per CCI edits - yes, 29877 is bundled with 29873 and cannot be billed separately. Code only the 29873.
{that's my opinion on the posted matter}
 

mbort

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I disagree with Donna as the AMA has documentation that supports the use of the -59 modifier.

If your documentation clearly supports that you are in a different compartment (either medial or patellofemoral), it is codeable with a 59 modifier. If the chondroplasty was performed in the lateral compartment you will not be able to code it.

I DO have documentation to support the above statement as well and will be happy to repost it or you may find it in other threads under the orthopedic section.

Hope this helps
Mary
 
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Cottrell

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Check code G0289. Medicare (and some otheres) will accept this for procedures done on a different compartment of the knee. We use the 29877-59 for the others, as long as it performed on a different compartment of the knee, carrier preference for reporting.
 

dmaec

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hmm...so either CCI Edits is incorrect or payers are paying incorrectly? I don't know, I tend to follow CCI Edits, they haven't lead me wrong yet ;)
 

mbort

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hmm...so either CCI Edits is incorrect or payers are paying incorrectly? I don't know, I tend to follow CCI Edits, they haven't lead me wrong yet ;)
Please keep in mind that the CCi edits are provided by Medicare. If you are familiar with orthopedics, then you are aware that the 29877 issue has been ongoing for close to 10 years now. Medicare has their own set of guidelines for the 29877. As you can see in the CCI edits the 29877 bundles with EVERY knee scope procedure. So IF this is a medicare patient then yes it does bundle but then you follow their guidelines that tell you to use G0289 for reporting purposes of the 29877.

If your company follows STRICLY Medicare guidelines then you would use the G0289.

However if not, and this is not a Medicare patient then you follow the AMA guidelines for reporting of the 29877.

Hope this helps clarify my reasoning. If you would like the CPT assistant comments on this I will be happy to send them to you or I have posted them in the orthopedic forum previously.

Mary
 

JillSmithers

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I disagree with Donna as the AMA has documentation that supports the use of the -59 modifier.

If your documentation clearly supports that you are in a different compartment (either medial or patellofemoral), it is codeable with a 59 modifier. If the chondroplasty was performed in the lateral compartment you will not be able to code it.

I DO have documentation to support the above statement as well and will be happy to repost it or you may find it in other threads under the orthopedic section.

Hope this helps
Mary
Can you share that documentation? I have a BCBS patient that had lateral release and chondroplasty of the inferior pole of the patella. I would like to be able to bill for both 29877 and 29873 because of being in two different compartments.
 

C.Lam

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Can you share that documentation? I have a BCBS patient that had lateral release and chondroplasty of the inferior pole of the patella. I would like to be able to bill for both 29877 and 29873 because of being in two different compartments.
I thought the lateral release is only performed in the patellar compartment, and since your chondroplasty is also performed in the same compartment, it does not qualify for a 59 modifier?

But can someone provide documentation? I have always seen the column 2 for the 29877 with 29873, and never given it a second look on NCCI. Nor have I considered the G0289. Is this a physician CMS billing only or are ASC billing applicable as well?
 
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