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2012 CPT Arthroscopy Revisions Pose Financial Hit to Both ASCs and Surgeons

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CPT copyright 2011 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

 

The following article is written by Cristina Bentin, CCS-P, CPC-H, CMA, president of Coding Compliance Management.


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)


29881Arthroscopy, 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).

 

+ 29826Arthroscopy, 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.

 

To contact Cristina Bentin ( This email address is being protected from spambots. You need JavaScript enabled to view it. ) and learn more about Coding Compliance Management, visit www.ccmpro.com.


The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.


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RAC Demand Letters: Surgery Centers Fight Back

 

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