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Coding for Knee Arthroscopy and Chondroplasty

Guideline changes related to chondroplasty and meniscectomy procedures

Mary LeGrand, RN, MA, CCS-P, CPC

The definition of a chondroplasty, reported with CPT code 29877 (“Arthroscopy, knee, surgical; debridement/shaving of articular cartilage [chondroplasty]”), did not change in 2012. What did change is the guideline instruction referring the physician and coding staff to CPT code 29880 and 29881 when a chondroplasty is performed with a meniscectomy (29880 or 29881). So, the ultimate change for 2012 is not with the chondroplasty CPT code but with the meniscectomy CPT codes.

The descriptions for CPT codes 29880 and 29881 were revised and now include a chondroplasty, regardless of the compartment in which the chondroplasty is performed. The descriptions read as follows:

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—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

Why make a change?
The rationale for this change appears in the American Medical Association (AMA) publication, CPT Changes 2012—An Insider’s View, and reads as follows:

“As part of the AMA RUC Relativity Assessment Workgroup (RAW) (formerly Five-Year Review Identification Workgroup) analysis of codes, the RUC concurred that codes 29880 and 29881 for reporting knee arthroscopy with meniscectomy are typically performed with 29877 for reporting arthroscopy of the knee requiring a chondroplasty (debridement/shaving of articular cartilage). To address the RUC recommendation that the three codes 29880, 29881 and 29877 be bundled, codes 29880 and 29881 were revised to include chondroplasty when performed and a cross-reference was added to direct users to codes 29880 and 29881 when arthroscopic chondroplasty is performed in conjunction with arthroscopic meniscectomy.”

What is the impact?
CPT code 29877 may never be reported when a medial and/or lateral meniscectomy is performed in the same knee, same operative session. The following examples provide guidance on implementing the new coding guidelines and bundled codes.

Example 1—The surgeon performs and documents arthroscopic left lateral meniscectomy and arthroscopic tricompartmental chondroplasty and reports code 29881. The chondroplasty is inclusive and not separately reportable even though the procedure is performed in two separate compartments. The chondroplasty is not reportable in lieu of CPT code 29881 because the documentation and medical necessity supported the meniscectomy as the primary procedure.

Example 2—The surgeon performs a right lateral meniscal repair and tricompartmental chondroplasty and reports the following codes:

29882—Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral)

29877-59—Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)

The surgeon appends modifier 59 to CPT code 29877 to indicate that a distinct separate procedure was performed in a different anatomic location (chondroplasty in the medial and patellofemoral compartments). CPT code 29882 does not include the chondroplasty as bundled.

Example 3—The surgeon performs a right medial meniscectomy, lateral meniscal repair and tricompartmental chondroplasty and reports codes 29882 and 29881-59.

Modifier 59 is appended to CPT code 29881 to indicate a distinct separate procedure in a different anatomic location (lateral repair vs medial meniscectomy).

Although CPT code 29882 does not bundle the chondroplasty, CPT code 29881 precludes the reporting of the chondroplasty in the patellofemoral compartment.

Reporting a chondroplasty to Medicare
Reporting CPT code 29877 to Medicare is not a problem if only the chondroplasty is performed, regardless of the number of involved compartments (ie, CPT rules apply). When reporting an arthroscopic chondroplasty in addition to any other arthroscopic knee procedures, however, the surgeon must use the Medicare G 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)—instead of the CPT chondroplasty code 29877. Remember, a chondroplasty is not reportable with a meniscectomy performed during the same session and on the same knee—this coding concept also applies to the HCPCS code G0289.

The following examples show the coding application according to Medicare payment rules for Medicare and private payers who follow Medicare payment rules.

Example 1—The surgeon performs and documents arthroscopic left lateral meniscectomy and arthroscopic tricompartmental chondroplasty and reports CPT code 29881.

The chondroplasty is inclusive and not separately reportable even though the procedure is performed in two separate compartments. G0289 may not be reported for the other two compartments because CPT rules state the chondroplasty is inclusive to the meniscectomy code(s).

Example 2—The surgeon performs a right lateral meniscal repair and tricompartmental chondroplasty. In this scenario, based on Medicare payment rules and instructions for G0289, the surgeon may report the meniscal repair code (29882) and two (2) units of HCPCS code G0289 for the chondroplasty in the medial and patellofemoral components. The format for reporting this code combination depends on the payer’s rules.

In line-item reporting, each CPT/HCPCS code is submitted on subsequent lines, as shown in Table 1.

The second reporting option applies if the payer requires using the bundled format and doubling the units for HCPCS code G0289, as shown in Table 2.

Remember: Medicare does not recognize CPT code 29877 with other arthroscopic knee procedures and requires the use of the G0289 code. In line-item coding, this code should be reported twice to show a chondroplasty in both the medial and patellofemoral compartments. Modifier 59 should be appended to indicate a distinct, separate procedure in a different anatomic location (chondroplasty in the medial and patellofemoral compartments).

Some payers may want the G code reported in units versus line item. In this situation, the G code can be reported per compartment if no arthroscopic knee procedure is performed in the compartment.

Example 3—The surgeon reports a right medial meniscectomy, lateral meniscal repair, and tricompartmental chondroplasty and reports codes 29882 and 29881-59.

The surgeon appends modifier 59 to CPT code 29881 to indicate a distinct separate procedure in a different anatomic location (lateral repair vs medial meniscectomy). CPT code 29882 does not include the chondroplasty as bundled; however, the inclusion of CPT code 29881 precludes the reporting of the chondroplasty (G0289) in the patellofemoral compartment.

Tips to remember

  • The operative note details must support all procedures stated as performed in the procedure title.
  • Code all services according to the CPT coding rules and use the AAOS Complete Global Service Data for Orthopaedic Surgery as an adjunct to the CPT rules.
  • Report all services to private payers using CPT rules—except in scenarios where the payer has provided specific written instructions on reporting payer-specific exceptions (G code).
  • Report HCPCS code G0289 only to Medicare (unless a private payer has provided specific written instructions related to this code).
  • Do not report HCPCS code G0289 to Medicare if the only procedure performed and documented is a chondroplasty. Instead, report CPT code 29877.
  • Do not report the chondroplasty CPT code 29877 if CPT code 29880 or 29881 is supposed to be reported.
  • When reporting nonmeniscectomy procedures, use CPT code 29877 only one time per operative session, regardless of the number of compartments and only if no surgery was performed in one compartment.
  • Report HCPCS code G0289 per compartment to Medicare or private payers that require this code if arthroscopic knee procedures other than a meniscectomy are performed at the same operative session, same knee. G0289 must be performed in a different compartment, but may be reported more than one time if no surgery is performed in that compartment. Do not report G0289 if meniscectomy procedures were performed (eg, medial and/or lateral meniscal surgery).
  • Append modifier 59 when appropriate to let the payer know that the subsequent procedure is a distinct and separate procedure. Do not use modifier 59 to report a chondroplasty in any compartment when performed with a medial and/or lateral meniscectomy in the same knee.
  • Watch reimbursements closely to ensure payers reimburse correctly on all code combinations.
  • Code correctly and appeal inappropriate denials.

Mary LeGrand, RN, MA, CCS-P, CPC, is a consultant with KarenZupko & Associates, Inc., and focuses on coding and reimbursement issues in orthopaedic practices. The information in this article has been reviewed for accuracy by the AAOS Coding, Coverage, and Reimbursement Committee. If you have coding questions or would like to see a coding column on a specific topic, email aaoscomm@aaos.org

AAOS Now
May 2012 Issue
http://www.aaos.org/news/aaosnow/may12/managing1.asp