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3 Critical Knee Arthroscopy Coding Pitfalls Impacting an ASC's Bottom Line

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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.

Documentation requirements:
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.

Coding guidelines:
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.

Coding guidelines:
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 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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