Quick Microfracture Question...

BCrandall

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If an arthroscopic knee microfracture is done on the patella and femoral condyle, can 29879 be coded for each compartment with a -59?
 

mbort

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Ishvindersingh..can you direct us to that Medicare rule? Are you confusing the 29877 with the 29879?

I have documentation from a coding seminar that I attended that states that the 29879 can be billed/coded per compartment.

Mary
 

codersumit

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Hi Mary,
Is there a way where you could please provide that documentation to me. I think that would be of immense help.
Best Regards,
Sumit Gandhi, CPC
Senior Manager
 

amitjoshi4

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Ishvindersingh..can you direct us to that Medicare rule? Are you confusing the 29877 with the 29879?

I have documentation from a coding seminar that I attended that states that the 29879 can be billed/coded per compartment.

Mary
Hi,

Mary must be stating this AAOS article published in AAOS Bulletin, April 2005. It states that:

Abrasion arthroplasty
AAOS guidelines permit reporting of abrasion arthroplasty if the documentation supports that debridement was performed down to “bleeding bone.” Abrasion arthroplasty is not limited by compartments and can be reported twice if performed in both the medial and lateral compartments (as 29879 and 29879-59 or -51, depending on carrier issues).

Many offices are reporting an abrasion arthroplasty (29879) when the documentation supports a chondroplasty (29877). Reporting a chondroplasty as an abrasion arthroplasty is considered “upcoding” and should not be done.
According to the AAOS GSD, code 29879 covers: synovial resection for visualization; removal of osteochondral and/or chondral bodies (attached); diagnostic arthroscopy; chondroplasty; lavage and drainage; lysis of adhesions, and manipulation of the knee. It does not include arthroscopic meniscectomy and/or repair or arthroscopic removal of loose bodies or foreign bodies 5 mm or greater and/or through a separate incision.

According to the August 2001 CPT Assistant, “When smoothing down the cartilage and/or drilling holes to create microfractures, code 29879 may be reported. Abrasion arthroplasty is usually performed to promote cartilage regeneration by creating access to blood and nutrients by smoothing down the cartilage and/or drilling holes to create microfractures. Code 29879 includes chondroplasty performed as part of the abrasion arthroplasty, so code 29877 should not be separately reported. If, however, chondroplasty is performed in a separate knee compartment, code 29877 may be reported separately. Modifier -59, Distinct Procedural Service, should be appended to indicate that a separate compartment was involved.”

The scenario depends on carrier issues. Medicare has always been tricky to understand than the local carriers and i believe we cannot completely rule out the Mary's view point.

We do follow AAOS and have never come upto any denials.

Thank You
 
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29879 with 29877

So would you agree that if a worker's compensation fee schedule in Illinois follows CCI edits that 29877 should not be paid when billed with 29879 and no different compartment is utilized? Looking for another opinion.
Thanks.
Pat P
 

BCrandall

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So would you agree that if a worker's compensation fee schedule in Illinois follows CCI edits that 29877 should not be paid when billed with 29879 and no different compartment is utilized? Looking for another opinion.
Thanks.
Pat P
I'd say it depends on how comprehensive the documentation is. According to the previous posts it's possible as long as there's a supportive note.
 
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