Billing 29880 & 29875 together for the same knee

Although the Medicare CCI Manual states 29875 shouldn't be billed with other arthro Px's performed on the same knee SelectCoder's documentation for 29875 states work on a separate compartment is acceptable w/other arthro Px's on the same knee. Is this correct? I've checked a few other reliable sources (AAPC, KZAssociates) and they seem to agree w/Medicare.

Below is some of the description from SelectCoder that's confusing me. Anyone else have any thought on this?

Thanks,
Jeff

This is a "separate" procedure, typically a component of a more extensive service; it may be reported when performed independently (i.e., within a different knee "compartment" than other arthroscopic procedures also performed) or when considered unrelated to other procedures performed at the same surgical session — see reference to modifier -59.

No other procedures are performed on this compartment of the knee

Comments

  • edited May 2017
    Unfortunately we cannot report 29875 when any other procedure is performed on the same knee due to the "Separate Procedure" designation. Please see:


    CPT Assistant
    Frequently Asked Questions - Surgery: Musculoskeletal System
    Published: 1/1/2016
    Effective: 1/1/2016
    Last Reviewed: 4/1/2016

    Question: My physician's operative report indicates that she performed the procedure described by 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, with the procedure described by code 29875, Arthroscopy, knee, surgical; synovectomy, limited (eg, plica or shelf resection) (separate procedure). Is it appropriate to report this code combination?

    Answer: No, CPT code 29875 (limited synovectomy) is described as a "separate procedure" which means that the work associated with this procedure is inclusive of more extensive procedures performed in the same anatomic site (the knee) and, therefore, is not separately reportable if other arthroscopic knee procedure is performed on the same knee in the same session. This code should only be reported if it is the only procedure performed.

    It should be noted that CPT coding guidelines may differ from third-party payer guidelines. Eligibility for payment, as well as coverage policy, is determined by each individual insurer or third-party payer. For reimbursement or third-party payer policy issues, contact your local third-party payer.

    ____________________________________________________________________

    Orthopedic Coder's Pink Sheet
    CCI 2014: New manual update restricts separate knee synovectomy billing
    Published: 12/20/2013
    Effective: 12/20/2013
    Last Reviewed: 12/20/2013
    Publisher: Orthopedic Coder's Pink Sheet

    New 2014 Medicare bundling policies for the knees and other joints as well as fracture care will require you to institute changes to the way you code. In many cases, you'll also need to prepare for lower reimbursement for these procedures.

    These strict new policies were included in the 2014 update to the National Correct Coding Initiative (CCI) Policy Manual, which takes effect Jan. 1. New Medicare coding rules added to Chapter 4 of the CCI manual restrict when you can bill arthroscopic knee synovectomy with other arthroscopic procedures in the same knee. To start, CCI states that "a synovectomy to 'clean up' a joint on which another more extensive procedure is performed is not separately reportable."

    That means:

    1. You should not report 29875 (Limited synovectomy [e.g., plica or shelf resection] [limited procedure]) with another arthroscopic knee procedure on the same knee, the CCI manual states.

    2. You may report code 29876 (Major synovectomy of two or more compartments [e.g., medial or lateral]) "for a medically reasonable and necessary synovectomy with another arthroscopic knee procedure on the ipsilateral [same] knee if the synovectomy is performed in two compartments on which another arthroscopic procedure is not performed."

    3. You now will be unable to separately report 29876 with 29880 (Medial AND lateral meniscectomy), CCI states.

    The new policy will severely limit your ability to bill for synovectomy in the same knee as other procedures, warns OCPS technical advisor Margie Scalley Vaught, CPC, CPC-H, CCS-P, ACS-EM, ACS-OR. "There goes your reporting of 29875 when working on the same knee," she explains. "Whenever it's a 'separate' or 'limited' procedure, the concept of separate billing when it's in a separate compartment doesn't apply."

    Remember that a meniscectomy includes synovectomy, Vaught says. Synovectomy also is bundled with chondroplasty and now all other arthroscopic knee procedures when done in the same knee compartment, she adds.

    You could separately report 29876 with other arthroscopy procedures on the same knee, but only when no other procedures are done in the same knee compartments.

    Example of when separate billing is allowed: If the orthopedist does a lateral meniscectomy and synovectomy in the medial and patellofemoral compartments, CCI says you could separately report both 29876 and 29881 (Meniscectomy [medial OR lateral, including any meniscal shaving] including debridement/shaving of articular cartilage [chondroplasty], same or separate compartments, when performed). That's because only one procedure is done in each compartment & they don't overlap.

    Example of when it is not allowed: if the doctor does medial meniscectomy and synovectomy in the medial and lateral compartments. Because the doctor does both a meniscectomy synovectomy in the medial compartment, the synovectomy would be bundled.

    CCI limits arthroscopic debridement

    Expect new restrictions on payment for debridement in arthroscopic surgeries you do on other joints besides the knee in 2014. A new policy added in CCI states: "With the exception of the knee joint, arthroscopic debridement should not be reported separately with a surgical arthroscopy procedure when performed on the same joint at the same patient encounter."

    The change appears to bundle shoulder debridement (29822 and 29823) with procedures such as capsulorrhaphy (29806), rotator cuff repair (29827) and biceps tenodesis (29828) when done on the same shoulder, Vaught says. You also won't be able to bill separate debridement done with arthroscopic surgical procedures in other joints, such as the elbow and wrist, she adds.

    For shoulders, CCI seems to be tightening the policy it added last year, which prevented you from overriding CCI edits to bill multiple arthroscopic surgical codes for the same joint, Vaught observes. The new policy seems to now bundle arthroscopic debridement done with any other arthroscopic procedure done in the same shoulder, elbow, wrist or ankle, she adds.

    OFFICIAL RESOURCE: Medicare CCI policy manual
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