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2012 Menisectomy CPT Codes

  1. #1
    Location
    Greenville, NC
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    Default 2012 Menisectomy CPT Codes
    Medical Coding Books
    The 2012 Menisectomy codes, 29880 and 29881, have been revised with the statement "same or separate compartment(s) when performed."

    The CPT code 29877 refers you to see 29880 or 29881 when 29877 is performed with arthroscopic menisectomy.

    I am interpreting this to mean that neither the 29877 or the G0289, for Medicare as well as those carriers that pay according to Medicare guidelines, will no longer be billable with 29880 or 29881.

    For example: Arthroscopic Medial & Lateral Menisectomy, code 29880, AND Chondroplasty of the Patella-Femoral compartment, 29877, can only be billed as 29880.

    Am I correct in my thinking?

  2. Default
    Unfortunately, yes, you are correct in your thinking. The 2012 arthroscopic procedure code changes are also going to affect shoulder cases as well.

    There was actually an article written by Cristina Bentin in Becker's ASC Review. Here is what it says...

    "While commonly performed arthroscopic procedures appear to see a slight per procedure reimbursement increase for ambulatory surgery centers in 2012 as compared to 2011, looks can be deceiving. Arthroscopic reimbursements for certain procedures are certain to take a hit due to 2012 code revisions.

    Knee scopes

    Chondroplasty procedures once reported separately to commercial payors when performed in a separate compartment than a meniscectomy will be inclusive to meniscectomy procedures commonly reported with CPT 29880 and CPT 29881.

    29880 — Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed (revised 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 (revised code)


    Let's compare:
    In 2011, when a lateral meniscectomy and a medial chondroplasty are performed on the left knee, ASCs report 29881-LT and 29877-59-LT to commercial payors that allow separate reporting.

    29881-LT: $1161.03 (approximate 2011 ASC reimbursement)

    29877-59-LT: $1161.03/2 = $580.51 (approximate 2011 ASC reimbursement, multiple procedure discount applied)

    In 2012, when a lateral meniscectomy and a medial chondroplasty are performed on the left knee, ASCs will report only 29881-LT to commercial payors due to the CPT code revision that includes chondroplasty in the same or separate compartment(s).

    29881-LT: $1,167.37 (approximate 2012 ASC reimbursement)

    Documentation tip: Orthopedic surgeons must describe the procedures performed in each compartment with as much detail as possible. Why? Providers will want to capture all separately reportable procedures. Don't forget about CPT 29879 — Arthroscopy knee, surgical; abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture.

    If the surgeon doesn't describe verbiage such as "debriding to bleeding bone" for an abrasion arthroplasty, the procedure may be misconstrued as a chondroplasty with no additional reporting or reimbursement when performed with an arthroscopic meniscectomy. Coding personnel should query when documentation leads to more questions than answers.

    As of this writing, CPT 29879 — Arthroscopy knee, surgical; abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture — when adequately described within the operative report may still be reported in addition to the 29880 or 29881 procedures.

    Shoulder scopes

    A common shoulder scope code, CPT 29826, becomes an add-on code in 2012 and may not be reported by itself. In most cases, an arthroscopic subacromial decompression is performed with other separately identifiable procedures. However, if the arthroscopic decompression is the only procedure performed/documented, add-on code +29826 cannot be reported as a stand-alone code.

    ASCs and surgeons should verify with individual carriers as to its reporting directives when an arthroscopic shoulder decompression of subacromial space (+29826) is the only procedure performed since the current recommendation in 2012 is an unlisted code (noncovered by Medicare in an ASC).

    +29826 — Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (i.e., arch) release, when performed (List separately in addition to code for primary procedure) (revised code)

    CPT code +29826 may only be reported in addition to the code for the primary procedure. Examples of primary procedures include but are not limited to arthroscopic rotator cuff repairs, arthroscopic debridements (the debridement would be performed on an area separate/distinct and unrelated to the work performed for the decompression) or an arthroscopic claviculectomy.

    Documentation tip: Orthopedic surgeons must detail all work performed in every area/region of the shoulder. Describe all tendons, muscles, tears (types), defects and anatomical areas in which work was performed and all techniques/methods (i.e. debridement, repair, excisions and/or releases).

    At this time, the proposed ASC national rate for +29826 is in question. Will the proposed rate remain unchanged once the final rule is published? The answer will determine whether ASCs will benefit, break even or take a hit from the revision. ASCs should verify correct national rates for add-on code +29826 when the final rule is published on/after Nov. 1."
    Tracey Thompson, CPC, CPPM

  3. #3
    Location
    Greenville, NC
    Posts
    21
    Default 2012 Menisectomy CPT Codes
    Thanks for the info Tracey. I hadn't even noticed the shoulder code revisions. I have only 1 Doc that said the revised knee codes made since. I hope the rest follow suit.

    Thanks again

  4. #4
    Default
    Tracy~ do you have a website that you've been able to get the CPT updates for 2012? I'm having difficulty locating this list for my chapter meetings. Any directions would be very helpful..

    TIA~
    Angie

  5. Default
    ALALA- I do not have a comprehensive list of the updates. The information posted above was actually from an article I read on the Becker's ASC Review website. This website has TONS of articles, but they are all ASC related, I don't know if that would help you any.

    Also on the Becker's ASC website there is an article posted regarding the AMA release of 2012 CPT code corrections. This article can be found on the main page, towards the very bottom. You may have to go to page 2, depending on how many articles are added between now and when you view it. The article is titled AMA Posts 2012 Codebook Corrections.

    Sorry I couldn't be of more help.
    Tracey Thompson, CPC, CPPM


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