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amartinez1

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My physician performed a lateral menisectomy, synovectomy in all three compartments, and chondroplasty in patellafemoral joint. Am I right to think that the synovectomy done in the medial can still be billed/coded along with the other procedures? I was coding this as 29881,29877-59, and 29875-59 or is correct to code 29887, 29877-59, 29876-59
 
I have a note written in my CPT book next to 29881 that says, only code chondroplasty if in seperate compartment and to code with LT or RT and 59 modifier.
 
amartinez1 said:
My physician performed a lateral menisectomy, synovectomy in all three compartments, and chondroplasty in patellafemoral joint. Am I right to think that the synovectomy done in the medial can still be billed/coded along with the other procedures? I was coding this as 29881,29877-59, and 29875-59 or is correct to code 29887, 29877-59, 29876-59
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I would code 29881 for Lateral menisectomy.
29877-59 for patellofemoral chondroplasty and
29875-59 for medial synovectomy.
 
cpccpma said:
What insurance? Medicare requires the G code. Other carriers want the G code as well.
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I didn't mention that because all states are different and the original question didn't specify G code, but if that is the case then you would bill as:
29881 lateral
G0289 patellofemoral
G0289-59 medial
 
I am confused when it comes to the NCCI Edits. It states that 29881 and 29877 in the modifer colums there is a zero, doesn't it that mean that those two codes can not be billed together not even with a modifier?
In that case if correct would the 29876 be ther correct code to bill? I thought these two codes can be billed together and not the 29876 but looking at the edits it says different. I also ask this because on a previous claim I billed the codes 29881, 29877, and 29876 and the insurance is denying the 29877 as bundled in with the 29876 code and I thought it was the opposite.
I also have a physician fee reference book that the physician uses and he says it states clearly that code 29881 can not be billed with 29875 by the same physician on the same day. But again according to NCCI edits under modifier column there is a 1 which states a modifier is allowed.
Can anyone please help clarify my confusion so I can better explain it to my physician?
Thanks in advance.
 
amartinez1 said:
I am confused when it comes to the NCCI Edits. It states that 29881 and 29877 in the modifer colums there is a zero, doesn't it that mean that those two codes can not be billed together not even with a modifier?
In that case if correct would the 29876 be ther correct code to bill? I thought these two codes can be billed together and not the 29876 but looking at the edits it says different. I also ask this because on a previous claim I billed the codes 29881, 29877, and 29876 and the insurance is denying the 29877 as bundled in with the 29876 code and I thought it was the opposite.
I also have a physician fee reference book that the physician uses and he says it states clearly that code 29881 can not be billed with 29875 by the same physician on the same day. But again according to NCCI edits under modifier column there is a 1 which states a modifier is allowed.
Can anyone please help clarify my confusion so I can better explain it to my physician?
Thanks in advance.
Click to expand...

Ok, Well I don't know how all states are, but in our office I only bill the G0289 instead of 29877 when billed with another procedure because 29877 is not billable with 29881. I only use 29877 if done alone.
Also, I think 29877 is bundled with most if not all codes. And no, you would not bill 29876 instead of 29877 that is not a replacement for that.
And 29881 can be billed with 29875 but since 29875 is a separate procedure code you need to add 59 modifier to that.
 
I am in the state of Texas. So which code is the primary procedure the 29877 or 29876. I have been recommended the Orthopedice Coding Guidlines Book but since it is so late in the year my physician thinks I should wait until January for the new year.
I have just received my certification and the knee joints are very confusing. If the 29877 should be billed versus the 29876 when done with the 29880 or 29881 then why would the insurance primarly United Healthcare say that the 29877 is bundled into the 29876. I know that Medicare only will allow the G0289 but I think this case is different.
 
You are correct regarding the NCCI edits however-the edit can be bypassed if 29877 is performed in a separate compartment. Medicare created the G code years ago and a few insurance companies started accepting that code-the allowable is so very low. UHC is one of the carriers that does want the G-code so bill your 29880 or 29881 and if the chondroplasty is done in the patellofemoral compartment then bill the g code too-they will pay. I am in Colorado and have had my claims paid based the separate compartment rule. Hope this helps a little. :)
 
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