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arthroscopy knee -need your help please

hlmcintyre

Guest
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35
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:rolleyes:Need your help!! Patient had a partial lateral menisectomy. Patient also had an excision of medial thickened plica band and excision of thickened synovium over the anteromedial compartment. I billed a 29881 (lateral compartment) and a 29875 with 59 modifier (medial compartment). The insurance company is telling me that the 29875 is included in the 29881 because of the 2012 CPT definition of code 29881 and will not pay for the
29875. I was always told if it was in a different compartment we could bill for this. Is this not correct anymore? Thanks for any help you can give me.
 

Jamie Dezenzo

True Blue
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857
Location
Mishawaka, IN
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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 (including 29877 here)

If not Medicare, I would appeal showing separate area and 29875 was the only procedure performed.
 

0913@70

Networker
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i have a scenario where surgeon did medial and lateral menisectomies (29880), partial synovectomy out in teh anterior condylar notch ove the remmant of the ACL and extra -articular acromioclavicular reconstraction posterior and medial cornet capsule repair (27427)

Can synovectomy be billed for this proc also, 29875.59?


Per Encoder pro limited synoevtomy is inclusive for 2012

Thnak you
 

hlmcintyre

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knee scope

Thanks Jamie for your advice. With these new CPT edits for the knee in billing for partial lateral menisectomy with a 29881, i felt i submitted the correct charges with the synovectomy of 29875 as he excised a medial plica and did a anteromedial synovium excision. I added a 59 to it so i was confused when the insurance company stated the 29881 includes shaving/debridement in the same/different compartment. This was excision of medial plica and synovium in the anteromedial compartment. It was not a chondroplasty. I wasn't sure if anyone else is having any problems with synovectomy being added to their 29881 or 29880 in a different compartment. Thanks
 

rharvel

New
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3
Location
Cape Coral, FL
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29876 & 29875 headaches!

I feel you on this issue! I am having issues with the synovectomy codes also (CPT 29875 and 29876). We billed 29881 & 29876 or 29880 and 29875 and rec'd denials. I've done peer reviews and had physicians tell me that i need to learn my guidelines because 29875 is designated as a separate procedure and is not allowed, period. I sent him the CPT Assistant for 2001 explaining that it is allowed and the code change effects debridements not synovectomy. Lets just say we are still fighting this but unfortunately I can't seem to get through to anyone! My insurance is Humana. The physician is NOT doing the synovectomy for "visualization" he is removing inflamed synovial tissue. Now they are telling us that the MD needs to describe and use adjectives to better depict their procedures. :mad:
 
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