CPT 29870 and 29875 are listed as separate procedure, which means they are usually bundled into the major surgery for the same anatomical site. They only be reported when they are performed alone or not on major surgery site. Mod -59 should not be using to unbundle them to pass edit when for same site.
Code 29875 is designated as a "separate procedure." Codes with the "separate procedure" designation normally would not be additionally reported when the procedure or service is performed as an
integral component of another procedure or service. However, when a procedure or service designated as a separate procedure is carried out independently or is considered unrelated or distinct from the other procedure(s) or service(s) provided at that time, then it would be appropriate to report the code in conjunction with the other procedure(s) or service(s). Modifier
-59, Distinct Procedural Service, should be appended to the separate procedure code to indicate that the procedure was distinct from the overall procedure. For example, if the knee arthroscopy with limited synovectomy were performed in a different knee compartment than another knee procedure, modifier -59 would be appended to code 29875 to indicate that a different compartment was involved.
| Arthroscopy, diagnostic of left knee, and arthroscopic medial meniscectomy of right knee |
CPT Assistant,
November 2019 Page: 14 Category:
Frequently Asked Questions
Question:
According to the CPT guidelines, a surgical endoscopy/arthroscopy always includes a diagnostic endoscopy/arthroscopy. Which CPT code should modifier 59 be appended to when a patient has a diagnostic arthroscopy of the left knee (29870) and an arthroscopic medial meniscectomy of the right knee (29881)?
Answer:
Modifier
59, Distinct Procedural Service, should be appended to the lesser valued code. Therefore, in this scenario, modifier 59 would be appended to code
29870, Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure), when it is performed on the contralateral knee and reported with code
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. Based on payer requirements, it may be appropriate to also append HCPCS Level II modifiers
RT, Right side (used to identify procedures performed on the right side of the body) (29881-RT) and
LT, Left side (used to identify procedures performed on the left side of the body) (29870-59-LT). Physicians may wish to contact their local third-party payers because reimbursement varies from payer to payer. Eligibility for payment, as well as coverage policy, is determined by each individual payers or third-party pay
