Wiki 29879 and 29999 billed together

Prezyna1

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Hello All - I am getting billed for 29879 WITH 29999 for coblation arthroplasty - same knee, same operative session
This does not seem right to me
AMA/CPT appears to be silent on this
Any information that can be supported as a denial of one or the other?
How can you debride to bleeding bone and then use a wand creating a smooth plasma surface over bleeding bone?
This provider is a notorious No Fault and WC over-biller
Thanks
 
Hard to say without looking at the operative report. What are they saying that the unlisted code represents? Debridement is usually considered inclusive to another procedure in the same joint since it's preparation of the surface and wouldn't warrant reporting separately unless it's something unusual.
 
Thank you for your response
29999, as per AMA/CPT is being properly billed for coblation arthroplasty which is very different from debridement - this is a knee arthroscopy
My problem is that they have also billed for 29879, abrasion arthroplasty down to bleeding bone
Medically, I don't understand how the coblation would be performed on top of bleeding bone
And if it is appropriate, I should think thatcoblation may be integral to 29879
 
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I'm thinking that an argument that 29879 includes chondroplasty and coblation is a form of chondroplasty - would lead to coblation being integral to the 29879
 
I agree with what you're saying, but again, without seeing the operative report I can't say if what is billed is correct or not. The provider may be using the unlisted code to represent the entire procedure and then inappropriately billing the listed code which should be considered inclusive, or they could be just using unlisted code to represent the additional work involved that is above and beyond the procedure that is reported with the listed code.

But since the unlisted code does not have any assigned description or value, it shouldn't make a difference here. I take it you are working for the payer, so it is your discretion to estimate the value of the unlisted code for payment purposes. So I would evaluate, as best you can, the cost of the complete procedure and then either subtract out the payment for 29879 and give the remainder to 29999. Or alternatively, you can pay the full value of the procedure to the unlisted code 29999 and deny 29879 as inclusive. Either way, it would come out to the same amount.

When an unlisted code is part of the claim, it becomes hard to say whether the coding is correct or incorrect since there is no clear meaning for what the unlisted code represents. Really, the provider should be telling you what they think it means, not just sending an operative report and letting you make the decision.
 
I agree with what you're saying, but again, without seeing the operative report I can't say if what is billed is correct or not. The provider may be using the unlisted code to represent the entire procedure and then inappropriately billing the listed code which should be considered inclusive, or they could be just using unlisted code to represent the additional work involved that is above and beyond the procedure that is reported with the listed code.

But since the unlisted code does not have any assigned description or value, it shouldn't make a difference here. I take it you are working for the payer, so it is your discretion to estimate the value of the unlisted code for payment purposes. So I would evaluate, as best you can, the cost of the complete procedure and then either subtract out the payment for 29879 and give the remainder to 29999. Or alternatively, you can pay the full value of the procedure to the unlisted code 29999 and deny 29879 as inclusive. Either way, it would come out to the same amount.

When an unlisted code is part of the claim, it becomes hard to say whether the coding is correct or incorrect since there is no clear meaning for what the unlisted code represents. Really, the provider should be telling you what they think it means, not just sending an operative report and letting you make the decision.
Thanks Thomas - It is clearly labeled on the bill and clearly documented and named in the operative report. And of course the BR charges for 29999 are absolutely out of any ballpark. CPT 29879 is also supported by the operative report narrative. I'm going to argue that coblation arthroplasty is a form of chondroplasty and that chondroplasty, by definition, is integral to 29879. My arguments are for an arbitration affidavit. Thanks for your input
 
I have been grappling with this question for some time. I thought I had found something from the AMA that said because coblation chondroplasty does not use mechanical devices as anticipated by 29877 that it should be billed with 29999. Must have been in a parallel universe that day because I could never find it again. But based on that I had allowed the coblation at 29877's fee. (I review New York no-fault claims for carriers that are in litigation.) I was not particularly comfortable with that so I kept digging. I found a CPT Assistant from 2009 regarding the use of a TOPAZ microdebrider. The AMA answered as follows:

The TOPAZ MicroDebrider is a tool which utilizes Coblation® technology to perform a small incision in the fascia and is considered an alternative to the use of standard surgical instruments such as scalpels, low frequency electrocautery, and so forth. This technology enables the microdebridement of soft tissue present within the tendons of the knee, shoulder, elbow, ankle and foot. Because the TOPAZ MicroDebrider is a tool and not a procedure, code selection will depend on the service performed, and the specific anatomy involved, as it can be used on different parts of the body. The appropriate code should be selected based on the definitive procedure being performed as described in the code descriptor. (Emphasis added.) [This is from an affidavit I drafted.]

I then found the following CPT Assistant from September 2020 that reinforces the notion that a code should be selected based on the definitive procedure, not the instrumentation used:

Question: If a surgeon performs a chondroplasty using a vapor ultrasound device at the same surgical setting as a medial meniscectomy, is it appropriate to report both procedures
separately?
Answer: No, the chondroplasty procedure is not reported separately when a medial meniscectomy is performed during knee surgery (eg, code 29881, Arthroscopy, knee, surgical;
with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s),
when performed).

So taken together these two CPT Assistants, I think, pretty clearly states that coblation chondroplasty is really nothing more than 29877 subject to all of the attendant rules.

That being said, Thomas is correct that the first stop is the op report.

BTW - does anybody have info on a "vapor ultrasound device" my searches have not been fruitful.
 
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