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medial menisectomy only?

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    29880 includes medial and lateral meniscectomy. His op is not significant enough to bill a repair of the meniscus. Sounds fraudulent since he wants to bill a lateral meniscectomy now.

    He would need do an addendeum if the op does not state MVA related. The Medial and lateral tears would be billed to MVA then, but he did not do the "typical repair of the lateral." Maybe try to billl it to the MVA with a 22 modifier on the lateral. The catch is you would be reducing the fee for the medial too since 29880 covers both.

    I would advise him on the situation and see what he suggests. He might be better off billing 29880 and 29877-59 vs 29880-52. He needs to dictate more of the lateral procedure to get that paid at full price.

    Good luck!

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    Quote Originally Posted by kibbit99 View Post
    29880 includes medial and lateral meniscectomy. His op is not significant enough to bill a repair of the meniscus. Sounds fraudulent since he wants to bill a lateral meniscectomy now.

    He would need do an addendeum if the op does not state MVA related. The Medial and lateral tears would be billed to MVA then, but he did not do the "typical repair of the lateral." Maybe try to billl it to the MVA with a 22 modifier on the lateral. The catch is you would be reducing the fee for the medial too since 29880 covers both.

    I would advise him on the situation and see what he suggests. He might be better off billing 29880 and 29877-59 vs 29880-52. He needs to dictate more of the lateral procedure to get that paid at full price.

    Good luck!
    29880 is not for a repair so that wont even come into play, its only for meniscectomy/debridement of the meniscus.

    I would suggest just the 29880 to whichever carrier, send the op note, and a letter from the doc stating which part is related to the MVA and let the insurance carrier work out the logistics with the other payor.

    An addendum would be nice too. This op note really does stink!
    Mary, CPC, CANPC, COSC

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    thanks guys!!!!

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    If the medial tear was caused by an accident, use the traumatic code, 836.0. If the lateral side is old and degenerative, use the 717.4x codes. Are there two carriers involved?

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    No, not that I know of, I only have the MVA insurance carrier, that's why I was confused.

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    You can bill the 29881 because it states Med or Lat menisectomy.

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    If the doctor performed a medial menisectomy for the injury it seems to me that the MVA carrier would be responsible for that part of the surgery. Did the doctor discuss the possibility of additional work being done? I'm not a biller, but what are the possibilities of billing the patient's insurance for the shaving of the old degenerative fraying of the lateral meniscus? Any other opinions on this?
    Last edited by coderguy1939; 08-13-2009 at 04:14 PM.

  8. #18
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    I think that would be double dipping which is why I suggested letting the two carriers work out the payment differential.
    Mary, CPC, CANPC, COSC

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    No, I agree with you, Mary, that 29880 should be used and the letter sounds like a good solution, but according to Bfaithful there only seems to be one carrier in the picture at the moment.

  10. #20
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    oh...i'm feeling kinda blonde...why did I think there were two carriers?? ok..well then...if the doc only wants to bill 29881 then he's leaving money on the table. This note supports 29880.
    Mary, CPC, CANPC, COSC

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