Wiki Chondroplasty or Meniscectomy

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jdibble

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I am having a debate with myself and am looking for some opinions and help!

If my doctor documents that he did an Arthroscopic Chondroplasty on the knee and also a medial and lateral meniscectomy, how would you code this? I know Chondroplasties are bundled with the meniscectomy codes, however with the RVUs higher for a Chondroplasty would it be proper to code just the 29877 or would you code only the 29880?

Any supporting documentation showing the correct coding for this would be appreciated also!

Thanks,
Jodi
 
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jdibble said:
I am having a debate with myself and am looking for some opinions and help!

If my doctor documents that he did an Arthroscopic Chondroplasty on the knee and also a medial and lateral meniscectomy, how would you code this? I know Chondroplasties are bundled with the meniscectomy codes, however with the RVUs higher for a Chondroplasty would it be proper to code just the 29877 or would you code only the 29880?

Any supporting documentation showing the correct coding for this would be appreciated also!

Thanks,
Jodi
Click to expand...
The CPT book itself tells you that if 29877 is performed with 29881 or 29880 that only 29881/82 can be billed as 29877 is bundled. You want documentation, it's in the CPT book.
 
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jdibble said:
I am having a debate with myself and am looking for some opinions and help!

If my doctor documents that he did an Arthroscopic Chondroplasty on the knee and also a medial and lateral meniscectomy, how would you code this? I know Chondroplasties are bundled with the meniscectomy codes, however with the RVUs higher for a Chondroplasty would it be proper to code just the 29877 or would you code only the 29880?

Any supporting documentation showing the correct coding for this would be appreciated also!

Thanks,
Jodi
Click to expand...
Hello,
Medicare actually created a G-code (G0289) that you may use to bill for a chondroplasty in addition to a meniscectomy (29880 or 29881) if the loose/foreign body was greater than 5mm or if it was removed through a separate incision. Obviously, this code only works for a Medicare, and not a private payer.
You can check out the article here https://www.aaos.org/aaosnow/2010/may/managing/managing2/
 
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You have to code the 29880. Think about it this way - would they have gone in there just to do the 29877 in the first place? Probably not. The reason for the surgery and intent of the procedure was the meniscectomy. Agree as above that the CPT description itself is the answer.

However, regarding the G0289, you have to be very careful trying to report that at the same time as a meniscectomy. It would have to be performed in a separate compartment which is highly unlikely. This is especially true with 29880. It would be more likely to see it with 29881. The documentation would have to be bulletproof. If they were doing 29880 medial/lateral you would have to be able to prove in the documentation that they were in the PF.

NCCI:

6. CPT codes 29874 (Arthroscopy, knee, surgical; for removal of loose body or foreign body (e.g., osteochondritis dissecans fragmentation, chondral fragmentation) and 29877 (Arthroscopy, knee, surgical; for debridement/shaving of articular cartilage (chondroplasty)) shall not be reported with other knee arthroscopy codes (29866-29889). With 2 exceptions, HCPCS code G0289 (Arthroscopy, knee, surgical; for removal of loose body, foreign body, debridement/shaving of articular cartilage at the time of other surgical knee arthroscopy in a different compartment of the same knee) may be reported with other knee arthroscopy codes. Since CPT codes 29880 (Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty) same or separate compartment(s), when performed) and 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) include debridement/shaving of articular cartilage of any compartment, HCPCS code G0289 may be reported with CPT codes 29880 or 29881 only if reported for removal of a loose body or foreign body from a different compartment of the same knee. HCPCS code G0289 shall not be reported for removal of a loose body or foreign body or debridement/shaving of articular cartilage from the same compartment as another knee arthroscopic procedure.
 
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Thank you everyone for your input. I understand what CPT says and all the other sources and have always coded it for just the meniscectomies. I also know about the G0289 and have used it appropriately in the past when documented. I have a provider who was questioning why he couldn't just bill the chondroplasty code for the whole procedure since it has a higher RVU than coding just the 29881 or 29880. He got me questioning the reasoning myself at that point so I reached out here for some back up information to support my coding to bring back to the provider. Usually when a procedure is bundled it is a procedure with a lower RVU than the primary procedure. This scenario is the reverse of that! It is like getting paid less for doing more work!

I really appreciate those who gave me the AAOS links as that was the information that I was looking at. As CPT does have direction and I am well aware of what is in the book, that was not sufficient for the doctor to explain why.

Thank you again for your kind responses!!
 
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*** As CPT does have direction and I am well aware of what is in the book, that was not sufficient for the doctor to explain why. ***

The coding instructions in the CPT should absolutely satisfy the doctor. The AMA owns the copyright to the book and they decide what a code includes and does not include. No, we don't always agree with their decisions and reasoning, but CMS follows these internal coding instructions. So when you look up code 29877 and see a coding instruction to use 29881 & 29880 if meniscectomy was performed, this is not a suggestion. This is a demand. You will use that code and CMS through the NCCI edits supports that decision. While 29877 has a higher RVU value than 29881, the coding instructions as set for by the AMA over-rides that. We may or may not agree with the coding instructions, but we do have to follow them.
 
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I would definitely hold your ground and advise the doctor that CPT coding guidelines prevail and also educate him on the ramifications of an insurance retro-audit and recoup based on incorrect coding. If it is a persistent pattern, the doctor (and you) can be opened up to fraud and abuse under The False Claims Act, but that would be an extreme case.
 
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