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Code arthroscopic knee procedures using G0289

HCPro Coder Connection, October 20, 2004

Just when you thought coding for arthroscopic knee procedures couldn't get more confusing, it did. In 2002, CMS unveiled a new HCPCS level 2 code G0289, "Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chrondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee."

To add further confusion to this code, CMS Program Memo A-02-129 provided hospital outpatient facilities more information. To assign G0289, the memorandum reads, the surgeon should document the time spent in each compartment of the knee. Facilities should only report the code if the surgeon spends at least 15 minutes performing the procedure in the additional compartment. They should not report the code if a problem caused by the arthroscopic procedure itself necessitates the second procedure.

G0289 is to be used when a procedure is performed in the lateral, medial, or patellar compartments, in addition to the main procedure. Be aware that the physician may not specifically document this information in the operative note, but ideally this is the best location. You may need more information.

This puzzling documentation and coding problem continues to pose challenges in both coding and reimbursement. To support billing, surgeons need to document the full details involved in performing the chondroplasty procedure, not just state, "Chondroplasty performed." Physicians' offices likely know of this requirement, but do not practice it; therefore, this is an excellent educational opportunity for surgeons.

According to a CMS memorandum, G0289 is incidental and will not generate a separate APC payment for hospitals. G0289 is a packaged service under OPPS and the facility will not receive additional payments. However, additional money is paid for the professional fee when G0289 is billed.

G0289 has opened up a can of worms surrounding documentation requirements because the federal government referenced time as a factor. In addition, if the procedures were performed on different knees, include with G0289 modifiers -RT and -LT to indicate the side for each separate procedure. CPT codes 29877 and 29876 have now been lumped into code G0289.

According to the CMS memorandum, it is inappropriate to assign and bill the following CPT codes with G0289.

29874, Arthroscopy, knee, surgical; for removal of loose body or foreign body (e.g., osteochrondritis dissecans fragmentation, chondral fragmentation).

29877, Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chrondroplasty) with other arthroscopic procedures on the same knee.

Here are the answers to the coding questions:  
1. A Medicare patient has an outpatient right knee arthroscopic medial chondroplasty with a right knee arthroscopic lateral meniscectomy. Code G0289-RT along with CPT 29881-RT.

2. A Medicare outpatient has a left knee arthroscopic foreign body removed from the medial compartment and a left knee arthroscopic anterior cruciate ligament reconstruction. Code G0289-LT along with 29888-LT.

3. A Medicare outpatient has a right knee arthroscopic loose body removed from the lateral compartment, and a right knee arthroscopic medical compartment and suprapatellear pouch synovectomy. Code G0289 with 29876-RT.

Tip: Remember G0289 is an add-on code and cannot be used alone, a Medicare coding and billing requirement. Always review the operative report carefully. Don't assume the physician has listed all reportable procedures in the statement of the operation performed.