Wiki Billing 29880/29881 with 29877

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McCheeseMH

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I am so confused. I have people telling me that you can't bill 29877 with 29880/29881.:confused: I have some payers that pay both and some payers that deny 29877. Everything I have read leads me to believe 29877 can be billed with29880/29881 when performed in a different compartment and submitted with the 59 modifier. I am wondering what is the correct way to bill this situation?
 
McCheeseMH,
From the AMA's coding perspective, it is appropriate to code the debridement with the appropriate modifer (59), if it is performed in a different area of the knee (e.g. medial and patellofemoral). However, some payers will not reimburse them separately. Do you have access to CPT Assistant Archives? It's in the June 1999 CPT Assistant. I've copied the text for you. Hope this helps. Thanks.

CPT Assistant June 1999 Surgery Musculoskeletal System, 29877 (Q&A)
Question
The February 1996 issue of the CPT Assistant featured a question in the coding consultation section regarding coding for an arthroscopy of the knee with a lateral meniscectomy and shaving the articular cartilage. Please clarify whether these procedures must be performed in separate compartments of the knee in order to separately report these procedures.
AMA Comment
Yes. In order to separately report arthroscopic debridement/shaving of articular cartilage (29877) and arthroscopic meniscectomy (29880, 29881) performed at the same session, the procedures must be performed in separate compartments of the knee.
To further clarify, there are three compartments of the knee commonly visualized during arthroscopic surgery: medial, lateral, and patellofemoral. When reporting meniscectomy and shaving of articular cartilage performed in separate compartments of the knee at the same session, appending the -59 modifier to the second procedure will communicate that the procedures were performed in separate compartments of the knee.
 
I work for an ortho practice and certain payers (in our state anyway) require that we use G0289 in lieu of 29877 for debridement in separate compartment. There is no modifier needed with this code as the code itself stipulates that the procedure was performed in a separate compartment. 29877 is bundled in 29880/29881 in CCI edits, but if I'm not mistaken you are allowed to bill it with a modifier 59 if it is in fact performed in a separate compartment.
 
We have been using modifier -59 but without success. 29877 continues to be denied. I am going to try G0289 on my Medicare claims, I don't think any other payer will recognize that code.:p
 
I have found that BCBS will not pay 29881 with 29877 at all. Medicare will pay with the G code, and it can be billed 2 times if in different compartments. United Health will pay 29881 with the 29877 using 59. I found many Ins. will pay except BCBS.
 
Yes it is bundled with a zero indicator, meaning you cant bill separately even with a modifier. We do bill it, as we have been advised by several consultants and by the CPT assistant article. Some payers do pay for it and some dont. we still bill them all though.
 
The rule for billing the 29877 or the Medicare G code is that the chondroplasty has to be performed in a separate compartment for 15 minutes of debridement, which has to be clearly dictated by the physician in order to get reimbursement from the carrier. If it is clearly documented then I would appeal any denials.
The CCI edits bundled the 29880 or 29881 with the 29877 about 3 years ago and that is when the G code for Medicare and the 15 minute rule came about. It was published in the Orthopaedic Coding Alert if you have access to the archives? So I don't think that the archive from the 1999 CPT assistant will do you very much good due to the more recent ruling.
 
G0289

I'm in Missouri, and several of our payors (Medicare, UHC, Blue Cross, Medicaid, Aetna & Cigna and some of our smaller ones) are all paying on the
G0289 code. They don't pay much, but they aren't requiring a 59 modifier either because the code by definition states its done in a separate location.
Barbara
 
Most payers have paid 29877-59 with an appeal letter explaining the seperate compartments... I just found out yesterday that BCBS is recognizing CPT G0289. Good luck
 
It is my understanding that in Ohio and Pa Medicare will not accept 29877 but they will accept G0289 however you can use 29877 with a 59 modifier if the chondroplasty was done in a seperate compartment for commercial insurances.
Anissia
 
McCheese, if you are billing for Medicare, you can try
G0289 instead. That should work for you. Same is the case for 29874 when it comes to MC.
Hope this helps
 
prcedure code 29877

Does anyone know which insurances in Florida recognize procedure code G0289 instead of 29877?

Thank you
 
Bill G0289 instead of 29877, when billing w/ 29880 or 29881. That is per AAOS and Medicare and other payers do pay for that as well. I haven't had a problem when billing G0289. This is in CT.
 
I am in New Mexico, surgical center and medicare along with most of our payers dont want to pay on either G0289 or 29877 even though documentation supports different compartment. they will only pay it the code is billed by itself
 
:rolleyes: I am in New Mexico, surgical center and medicare along with most of our payers dont want to pay on either G0289 or 29877 even though documentation supports different compartment. they will only pay it the code is billed by itself
 
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