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Topic: Be a G whiz: Understand when to assign G codes (part one)

Ambulatory Surgery Reimbursement Update, November 4, 2008

Coding for orthopedics can be complicated due to the complexity of the anatomy involved in the procedures. But sometimes, even the coding basics can trip up coders.

For example, coders may want to brush up on their knowledge of the G codes, particularly G0289 and G0260, and when to assign them.

When coding a knee chondroplasty in conjunction with another procedure in a separate compartment for a Medicare patient, many coders mistakenly assign code 29877, says Susan Kiser, CPC, an independent coding consultant based in Broken Arrow, OK.

For example, if the physician performs a medial meniscectomy (code 29881) in the medial compartment in conjunction with a chondroplasty, coders should report code 29881 to report the primary procedure and Healthcare Common Procedure Coding System Level II code G0289 to report the chondroplasty, Kiser says.

But if this is a Medicare patient, and the physician performs only the knee chondroplasty, then code 29877 is the appropriate choice. Note that for Medicare patients, coders should assign code G0289 instead of 29877. However, coders can still use code 29877 for commercial payers.

“The most important thing coders need to know is exactly what payer they are dealing with before they begin coding the operative report,” Kiser says.

In this case, coders should report the G code for data tracking purposes, but not reimbursement, because code G0289 is considered packaged and ASCs cannot bill it because it has an N1 payment indicator attached, Kiser says.

But it’s important for coders to report code G0289 because CMS tracks the frequency of these codes when it sets fees, she adds.

Editor’s note: This topic is from the November 2008 issue of Ambulatory Surgery Coding and Reimbursement Insider.

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