3 Critical Knee Arthroscopy Coding Pitfalls Impacting an ASC's Bottom Line
Written by Cristina Bentin, Principal, Coding Compliance Management | March 31, 2010 | Print |EmailCPT copyright 2009 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
1. Reporting CPT 29877 instead of 29879 due to lack of documentation without consideration of a physician query
One of the biggest challenges in coding knees occurs with the determination of reporting CPT 29877, arthroscopy knee, surgical; debridement/shaving of articular cartilage (chondroplasty) vs. CPT 29879, arthroscopy knee, surgical; abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture. With detailed operative documentation, code selection isn't a challenge. However, documentation deficiencies will result in incorrect code selection and in some cases a loss in reimbursement. Consider the following excerpts from actual clinical documentation:
An example of poor documentation (original excerpt): "Next, I performed an abrasion chondroplasty in the lateral compartment. Attention was then turned to the medial compartment, where again, another abrasion arthroplasty was performed."
This documentation does not detail or describe the procedure and the verbiage is not consistent. The lack of clarity may lead some coders to code CPT 29877 once for the entire case. And why not? It gets the account coded and billed timely, correct? Absolutely not. Coding is based on detailed information that is very specific. When documentation leaves more questions than answers, the resolution would be to query the physician to verify the procedure performed and to receive more written clarification in the form of an addendum.
Let's look at the same excerpt after a query is made and an addendum is inserted into the operative report:
Better documentation (addendum to original excerpt): "In the lateral compartment, an abrasion arthroplasty was performed with debriding down to bleeding bone. Attention was then turned to the medial compartment, where again, an abrasion arthroplasty was performed with debridement down to bleeding bone."
Code selection for the description above would be CPT 29879 x 2 rather than CPT 29877 x 1.
2. Reporting 29879 incorrectly when performed in separate compartment as opposed to 29877 x 1 regardless of the number of compartments performed
As indicated in the preceding description above, the correct CPT code selection is 29879; 29879-59. Note: If the coder had not queried, the account would have been either underreported with only CPT 29877, a loss in reimbursement for your ASC, or it would have been overreported based on assumptions utilizing CPT 29879 and 2987959. While the latter provides the correct CPT codes, the original deficient documentation would not have supported code selection.
According to the American Academy of Orthopaedic Surgeons, "The abrasion arthroplasty or microfracture code (29879) is appropriate when the procedure exposes bleeding subchondral bone." Documentation must support this.
American Medical Association and the American Academy of Orthopaedic Surgeons: The AMA and AAOS allow the separate reporting of CPT 29879 in each of the three compartments of the knee whereas CPT 29877 may only be reported x 1 regardless of being performed in each of the three compartments of the knee. Remember, when CPT 29877 is performed in the same compartment where another arthroscopic knee procedure is performed, it is more than likely bundled and not separately reported.
CMS: When a chondroplasty is the only procedure(s) performed during the operative session, CMS allows reporting of CPT 29877 x 1 regardless of being performed in each of the three compartments of the knee.
3. Incorrectly reporting CPT 29877 vs. HCPCS Level II Code G0289 when indicated
Our last coding challenge comes with determining the reporting of CPT code 29877 vs. HCPCS Level II Code G0289, Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee, when a meniscectomy if performed in a separate compartment from the chondroplasty.
Prior to code determination, the facility must be knowledgeable of the type of carrier (commercial vs. Medicare) for the account being reported.
Let's say an arthroscopic medial meniscectomy is performed with an arthroscopic lateral chondroplasty of the knee.
Commercial: If the account is a commercial account that follows AMA guidelines, we would report CPT codes 29881; 29877-59.
Medicare: If the account is a Medicare account, we would report CPT codes 29881; G0289.
Recall, G0289, while on the Medicare ASC list of approved procedures, is listed with an N1 indicator. Reimbursement for G0289 is packaged into the reimbursement for the main procedure performed (meniscectomy) during the operative session. Facilities should follow billing guidelines for HCPCS listed as N1, since individual state ASC billing policies may differ in regards to dropping these HCPCS to a claim.
AMA and AAOS: The AMA and AAOS allow reporting of CPT code 29877 with the applicable modifier in addition to a meniscectomy when performed in a separate and distinct compartment from the meniscectomy. To reiterate, CPT 29877, when not bundled into other procedures, can only be reported one time per joint no matter how many additional compartments the procedures was performed.
CMS: When a meniscectomy is performed in one compartment and a chondroplasty is the only procedure performed in a different compartment than the meniscectomy, CMS requires reporting HCPCS Level II code G0289 instead of CPT 29877; therefore, package G0289 into the reimbursement for the main procedure (N1 indicator — see the Medicare ASC list of approved procedures). Note: HCPCS Level II G0289 may be reported a maximum of two times.
CMS does not allow substitution of G0289 with CPT 29877 simply to receive additional reimbursement.
Cristina Bentin can be reached at firstname.lastname@example.org. Learn more about Coding Compliance Management.
The information provided should be utilized for educational purposes only. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
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From the AMA's coding perspective, it is appropriate to code the debridement with the appropriate modifer (59), if it is performed in a different area of the knee (e.g. medial and patellofemoral). However, some payers will not reimburse them separately. Do you have access to CPT Assistant Archives? It's in the June 1999 CPT Assistant. I've copied the text for you. Hope this helps. Thanks.
CPT Assistant June 1999 Surgery Musculoskeletal System, 29877 (Q&A)
The February 1996 issue of the CPT Assistant featured a question in the coding consultation section regarding coding for an arthroscopy of the knee with a lateral meniscectomy and shaving the articular cartilage. Please clarify whether these procedures must be performed in separate compartments of the knee in order to separately report these procedures.
Yes. In order to separately report arthroscopic debridement/shaving of articular cartilage (29877) and arthroscopic meniscectomy (29880, 29881) performed at the same session, the procedures must be performed in separate compartments of the knee.
To further clarify, there are three compartments of the knee commonly visualized during arthroscopic surgery: medial, lateral, and patellofemoral. When reporting meniscectomy and shaving of articular cartilage performed in separate compartments of the knee at the same session, appending the -59 modifier to the second procedure will communicate that the procedures were performed in separate compartments of the knee.
Happy Coding, Claudia
Claudia Yoakum-Watson, CPC
Coding, Compliance, & Reimbursement Solutions
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