Question

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HIM Case Study 4.33 The billing officer manager has enjailed you about an issue large number of denials on arthroscopic meniscectomy pro The denials are related to codes 29880 and 29876 when bo or 50. He is wondering if these denials can be appealed. per perform an internal audit of knee arthroscopic meniscectomy pro pout an issue with patient accounts. They are so celomy procedures of the knee for Medicare Part Hled with modifiers LT, RT. by using another modifier. You omy procedures and identify the following: same knee 64 percent of the time with two of your 29888 and 29878 are being coded together for the same knee o three outpatient coders responsible for these code assignments. priateness of this coding practice and whether or 1. Based on NCCI edits elaborate on the appropriateness of this cod not the denials can be appealed. 2. Develop a process to ensure that NCCI arthroscopy guidelines al 54 Oscopy guidelines are followed. Resources Casto, A.B., 2018. Revenue Cycle Management. Chapter 9 in Prin venue Cycle Management. Chapter 9 in Principles of Healthcare Reimbursement, 6th ed. Chicago: AHIMA. Centers for Medicare and Medicaid Services, 2019. NCCI Policy Manual for Medicare Services.

The billing officer manget has emailed you about an issur with patient account. They are getting a large number ofndenials on arthroscopic menisectomy procedure of the knee for medicate patients.The denial related code 29880 and 29876 being. oded together for the sane knee to to code

Answer 1

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

29881   with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed

29882 with meniscus repair (medial OR lateral)

29883 with meniscus repair (medial AND lateral)

Meniscectomy (29880, 29881) and meniscal repairs (29882, 29883) may be performed alone or with other services, and often are the primary service. Meniscectomy involves surgical removal of all or part of a torn meniscus, while 29882 and 29883 are used when the meniscal tear is repairable.

A key concept in reporting meniscectomy and meniscal repair is that of knee compartments. CPT®, AAOS, and Medicare all recognize three anatomic compartments in the knee (medial, lateral, and patellofemoral). CPT® definitions, GSD guidelines, and NCCI guidelines are based on whether meniscal or other procedures are performed in one or multiple compartments. In some cases, a second procedure may be reported if performed in a separate compartment; whereas, if performed in the same compartment as the primary procedure, it’s not separately reportable.

This is a case of CMS providing specific reporting guidance for a procedure. CPT code 29880 is defined as “same or separate compartments.” CMS has defined that they will not cover the removal of a loose body in the same compartment of the knee when a meniscectomy is performed. This is part of the procedure; you have to remove the loose bodies while in the compartment where the meniscectomy is performed. They do provide HCPCS code G0289 for removal of a loose body in a different compartment of the same knee. While other payers may accept 29874-59 per CPT guidelines, CMS considers this part of the other procedure. NCCI Manual, Chapter 4, states:

6. CPT codes 29874 (Surgical knee arthroscopy for removal of loose body or foreign body) and 29877 (Surgical knee arthroscopy for debridement/shaving of articular cartilage) should not be reported with other knee arthroscopy codes (29866-29889). With two exceptions HCPCS code G0289 (Surgical knee arthroscopy for removal of loose body, foreign body, debridement/shaving of articular cartilage at the time of other surgical knee arthroscopy in a different compartment of the same knee) may be reported with other knee arthroscopy codes. Since CPT codes 29880 and 29881 (Surgical knee arthroscopy with meniscectomy including debridement/shaving of articular cartilage of same or separate compartment(s)) include debridement/shaving of articular cartilage of any compartment, HCPCS code G0289 may be reported with CPT codes 29880 or 29881 only if reported for removal of a loose body or foreign body from a different compartment of the same knee. HCPCS code G0289 should not be reported for removal of a loose body or foreign body or debridement/shaving of articular cartilage from the same compartment as another knee arthroscopic procedure. This paragraph was relocated here from Section H (General Policy Statements), paragraph 11 in 2014.