Help with meniscectomy/synovectomy/chondroplasty

cbheusman

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I was hoping to get some help on this procedure. Op note states:

Medial and lateral femoral chondroplasty, medial and lateral meniscectomy, diagnostic and surgical arthroscopy with a two-compartment synovectomy.

Am I correct in thinking the chondroplasty and synovectomy are included in the meniscectomy? Any help would be greatly apprectiated!

Cathy
 
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Double check the compartments. (and payers)
29880 - Meniscectomy can be billed with a 29876 Synovectomy using modifiers according to payers, however the 29876 Synovectomy and 29877 Chondroplasty are bundled.
For the Chondroplasty, consider using the G0289 -this is not bundled with the other codes, and can be reported X2 if the physician perfoms these procedures in two compartments. Don't forget your modifiers or this may be a headache for you.
As for the diagnostic arthroscopy, I would only bill this if it was done in the Patello Femoral compartment as surgical procedures were done in the medial and lateral compartments.
Hope I didn't confuse you much! Have a great day!
 

cbheusman

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Patricia,

That didn't confuse me at all and I appreciate your help! This is a Medicare patient and sometimes Medicare makes me a little nervous.:)

Thanks again for your help!
Cathy
 

mbort

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If the synovectomy was done in the medial and lateral compartments you can not count them as a separate compartments as you were already in those compartments doing the menisectomy. You can only award for the PF compartment which knocks the code down to the 29875-59. I was taught to seperate the compartments into M-L-PF, jot down what was done in each compartment and code accordingly. You can not double dip into the same compartment twice. Hope this makes sense. I have some material from a coding seminar on this as well.
 

cbheusman

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mbort,
Thanks so much for the response. So I can be clear-since all three of these were done in medial and lateral compartments I would only be able to bill 29880. Coding G0289 is the same principle as for the synovectomy, correct? Would you happen to have a link online to the information you got from the seminar?
Cathy
 
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That is correct Cathy. The Synovectomy can only be billed if performed in an additional compartment... in this case, the surgeon would have had to do this in the PF compartment.
G0289 is an add on code, but can only be reported if performed in a seperate compartment than the meniscectomy as well. Here is the info from the AAOS which I was able to access... (however it refers only to the G code - same idea when it comes to billing for compartments though)

http://www2.aaos.org/aaos/archives/bulletin/jun03/cod.htm

Since Mbort has some info from a coding seminar... it may be more recent.
Mbort, would you mind sharing this with me as well?? We can never have too much supporting documentation!! Thanks!!! Have a great day everyone!:)
 

ceejay413

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Some clarification on G0289 from Federal Register, Vol. 67, No. 251/Tuesday, December 31, 2002/Rules and Regulations-

"G0289- Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee."

G0289 can only be used to replace 29877 or 29874, not 28975 or 29876.

Of note, according to the Federal Register report, "The code may be reported twice (or with a unit of two) if the physician performs these procedures in two compartments in addition to the compartment where the main procedure was performed."

For example- if the physician did a medial meniscectomy, lateral meniscectomy, and a patellofemoral chondroplasty, you can bill it as 29880, G0289.

However- if a loose body was removed in addition to that from any of those compartments, you cannot bill G0289, even though AAOS says you can bill 29874 in the same compartment when the loose body is greater than 5mm. The reason for this is that Medicare was incredibly specific in NOT wanting us to bill G0289 for any procedure done in the same compartment as the main procedure being performed.

BUT- (one last example)- if the physician did a medial meniscectomy (836.0), patellofemoral chondroplasty (717.7) and an excision of a loose body that's 7mm (717.6), you can bill it as 29881, G0289, G0289-59.

Hope that helps!!!
 
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