Wiki multiple loose body removals

[NEOSM507]

Hello,

Does 29874 describe one loose body removal (each) or multiple loose body removals if performed in the same session, same site, same incision.

Thank you

 

[Orthocoderpgu]

Code 29874 is for arthroscopic removal of loose bodies so same incision does not apply. Since 2017 the CMS NCCI Surgical Policy Manual has stated that 29874 cannot be billed with any other arthroscopic code. So basically you can bill 29874 on its own or not at all. If there is a rare circumstance that you can bill it, you would only be able to bill once, not multiple times. I know that other coders are going to say that per AAOS you may bill 29874 if the loose body is 5mm or larger. If your insurance is following CMS guidelines and the NCCI edits, size of the lose body won't matter. If you find an insurance that is not following the NCCI edits, you may bill it but don't be surprised if it gets denied when billed with other arthroscopic procedures which is almost always the case. I had once case where the loose body was so big that it would not fit through any arthroscopic equipment and the physician had to make a separate surgical incision to remove it, UHC still denied as "loose bodies are not payable".

 

[NEOSM507]

Code 29874 is for arthroscopic removal of loose bodies so same incision does not apply. Since 2017 the CMS NCCI Surgical Policy Manual has stated that 29874 cannot be billed with any other arthroscopic code. So basically you can bill 29874 on its own or not at all. If there is a rare circumstance that you can bill it, you would only be able to bill once, not multiple times. I know that other coders are going to say that per AAOS you may bill 29874 if the loose body is 5mm or larger. If your insurance is following CMS guidelines and the NCCI edits, size of the lose body won't matter. If you find an insurance that is not following the NCCI edits, you may bill it but don't be surprised if it gets denied when billed with other arthroscopic procedures which is almost always the case. I had once case where the loose body was so big that it would not fit through any arthroscopic equipment and the physician had to make a separate surgical incision to remove it, UHC still denied as "loose bodies are not payable".

thank you.. it was the only procedure performed and he removed 2 loose bodies so he wants to report it twice. Would that be appropriate?

 

[Orthocoderpgu]

No, it can only be billed once no matter how many loose bodies are removed. In seven years of coding ortho surgeries I have never seen a knee procedure where only loose bodies were removed.

 

[twizzle]

In addition, the CPT descriptor for 29874 does not say 'each' implying that you would not bill it separately for every loose body removed.