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Menisectomy and Excision of Loose Body

cwilson3333

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Hamilton, VA
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Good Morning Everyone,

Question on denial of removal loose body, knee.
Should the 29874 be appealed or was denial correct?


OPERATIVE NOTE:
Medial Menisectomy: [29881] [paid]

Chondroplasties:
Medial and lateral joint lines [29877-59] Denied [Correctly]

Excision Loose Body: CPT 29874 [Denied]
Op note states articular cartilage damage down to bone in tibia, where there was
a loose body, 1 square cm, with bone in the center.

Would someone please get back to me on this. Insurance is Cigna
 

armen

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Atlanta
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Good Morning Everyone,

Question on denial of removal loose body, knee.
Should the 29874 be appealed or was denial correct?


OPERATIVE NOTE:
Medial Menisectomy: [29881] [paid]

Chondroplasties:
Medial and lateral joint lines [29877-59] Denied [Correctly]

Excision Loose Body: CPT 29874 [Denied]
Op note states articular cartilage damage down to bone in tibia, where there was
a loose body, 1 square cm, with bone in the center.

Would someone please get back to me on this. Insurance is Cigna
I would code only 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.
29877-59 is wrong since 29881 already includes condroplasty in any comparment and 29874 is a component of 29881 and modifier is not allowed to unbundle it. Hope this helps.
 

armen

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Atlanta
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AAOS CodeX allows 29874 with 29881 when larger than 5mm.
Well if modifier is not allowed then How would you override the edit? Here is what CIGNA says:

Procedure Description 29874 ARTHROSCOPY, KNEE, SURGICAL; FOR REMOVAL OF LOOSE BODY OR FOREIGN BODY (EG, OSTEOCHONDRITIS DISSECANS FRAGMENTATION, CHONDRAL FRAGMENTATION) Modifier Disallow
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



Response:


CIGNA has adopted certain National Correct Coding Initiative (NCCI) edits and incorporated those edits into its clinical code auditing logic. This code combination is subject to an NCCI incidental edit. Many NCCI edits are based on the standards of medical/surgical practice. Per NCCI coding principles, the denied service is usually necessary to complete the comprehensive service and/or is not separately distinguishable from the comprehensive service. Procedures considered incidental when billed with related primary procedures on the same date of service will not be separately reimbursed. In some unique clinical circumstances, payment for both procedures may be appropriate if the services are separate and distinct, coded with the correct modifier, and appropriate supporting documentation be submitted. In some situations CIGNA may request that supporting documentation be submitted initially with the claim.

To learn more about CIGNA's Modifier Reimbursement policies, please visit CIGNA's secure website for Health Care Professionals at www.cignaforhcp.com.

Please Note: CIGNA applies NCCI coding rules to knee arthroscopy procedures. CPT Codes 29874 and 29877 should not be reported with other knee arthroscopy codes (CPT Codes 29866-29889). A modifier will not override this incidental edit. In place of CPT Codes 29874 or 29877, HCPCS Code G0289 must be used to report arthroscopies performed in the secondary or tertiary compartments of the same knee at the same time as the primary knee arthroscopy procedure.
 
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