We have a serious problem with Cigna not wanting to pay for the thermal chondroplasty of the patella as an unlisted code (29999). The Doc is using 29879 and Cigna is writing back to us stating in the denial letter to use 29879or 29877 because they state it is more specific.

I have research this to great lengths and have found that this is an unlisted code. The American Academy of Orthopedics (AAOS) - "AAOS Bulletin - April 2005" and the CPT Assistant , volume 8, Issue 10, October 1998, states that this is an unlisted procedure.

In my letter to Cigna I had brought all of this information out. I had also brought out additional facts from the articles stating, "that this would be considered upcoding and according to CPT guidelines that is it incorrect to select a code that "merely approximates" the service being rendered and specifies that the anatomically specific unlisted code should be used - 29999." I also used the information from the Coders Desk Reference describing what each procedure code the Doctor would have to have performed - (29877, 29879) - and they still denied all the payments.

Their next denial letter claimed that, " this was an integral part of the other procedures because the services were performed at the same time as a primary procedure, and required little additional resources."

I would like to give you the facts about each case: the Doctor goes into a different compartment to repair the cartilage and that is the only thing he does in that compartment. He uses low power thermal energy to smooth down the cartilage. The Doctor also uses this procedure to tighten the joint, either in the shoulder or the knee.

This has amounted to a considerable amount of money and time on our part, so I was asking for help on this matter. I do want to thank anyone for whatever help they can give. Thanks.

If you want to reach me my emial address is: deborah.robinson@hceheathcare.com