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Coding tip: Coding an unlisted arthroscopic procedure

Ambulatory Surgery Reimbursement Update, March 13, 2007

When a surgeon performs a procedure arthroscopically and you don't see a specific code in the arthroscopic section of the CPT manual, but you see a code for the procedure performed as an open procedure, you must code using the Unlisted Arthroscopy code (29999) rather than using the code for the open procedure.

Do not use an open code for a procedure performed arthroscopically as Medicare considers this a fraudulent practice.

You should follow this same rule for laparoscopic and endoscopic procedures. Send a copy of the operative report for the claim to be manually reviewed when using an unlisted code. If other procedures were performed, list the unlisted code as the last procedure code on the claim form.

This tip is brought to you by Ellis Medical Consulting, Inc.

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