Tricompartmental chondroplasty

smcbroom

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OK, here is my dilemma....I have a Medicare patient and the doctor dictated he did a right knee arthroscopy with tricompartmental chondroplasties and a limited synovectomy was performed throughout the anterior aspect of the joint. I know about the G0289 code but a while ago I called Medicare and they told me G0289 is not payable in an ASC (which is who I work for) so what would be your recommendation for the appropriate code(s)? My CCI edits say the 29875 would be the greater procedure so I'm needing some advise. Any would be appreciated!

Thanks,
Susan
 

mbort

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If the planned procedure was for the chondroplasty, then you would bill for the 29877. The only time you would use the G0289 is when there is another arthroscopic procedure, which I know in this case you said he did a limited synovectomy, but I am thinking that the synovectomy was not the planned procedure and therefore incidental to the chondroplasty. Even though the synovectomy may have a higher payment rate..it was not the primary procedure and would bundle into the 29877 since he was already in all three compartments.

However if I am incorrect above..then you would use the 29875/6 and then the G0289 (and yes..Medicare does not pay for it...its a reporting tool)

Make sense?
 

smcbroom

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it does make sense, but someone I consulted about this said it should be coded 29877 then G0289x2. Is this correct?
 

Frosty

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It's always been my understanding that if only chondroplasty is done, you would only bill it 1x (29877) no matter how many compartments you do. However, if you do, for instance, a meniscectomy in the medial compartment and then do a chondroplasty in the patellofemoral & lateral compartments, then you would bill 29881, G0289, & another G0289. If you do meniscectomy in the medial & lateral compartments (29880) & chondroplasty in the patellofemoral comp., then 29880 & G0289. That's what we've been taught in seminars. By the way - the G0289 is just for Medicare.
If the insurance is other than Medicare, then you can bill 29881, 29877-59 (separate compartment) for the first scenario & 29880, 29877-59 (sep.comp) for the 2nd scenario. Hope this makes sense.
 

astephens

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I work in a ASC and I was just told not to bill for 29877 unless is for a medicare patient, so who is right and who is wrong? does anybody know where this information came from? :confused:
 
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