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Topic: Avoid coding mistakes for orthopedic procedures

Ambulatory Surgery Reimbursement Update, March 25, 2008

Coding audits often reveal missed revenue potential, especially with respect to commercial carriers, when coding for arthroscopic chondroplasties performed in a separate compartment from the primary procedure.

Medicare won't reimburse a chondroplasty when performed in a separate compartment from the primary procedure, as it considers the procedures packaged, according to the new payment system. Coders should therefore report this scenario using G0289 with payment indicator N1. However, some commercial carriers do allow separate reporting of a chondroplasty that a physician performs in a separate compartment-provided it doesn't bundle into any other procedures, if any, performed within that compartment.

Physician documentation that lacks relevant details about the procedures performed within each compartment can also lead to inaccurate code selection. For example, physicians might document that they are "debriding," but not say what they're debriding, says Cristina Bentin, CCS-P, CPC-H, CMA, founder of Coding Compliance Management in Baton Rouge, LA. This can make it difficult for the coder to know how to code the procedure. Also, the coder may not understand where the surgeon worked in the knee because the physician's notes lack clarity.

Coders should report CPT code 29877 for the debridement of chondromalacia, but should report CPT code 29881 for a debridement of the lateral or the medial meniscus. This is an important distinction. Code 29877 often ends up bundled with other services, whereas 29881 is seldom bundled into other procedures performed during the same operative session.

Editor's note: This topic is from the April 2008 issue of Ambulatory Surgery Coding & Reimbursement Insider. To read the article, click here.

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