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Coding Corner: Straighten Up Your Knee Surgery Coding

3 tips smooth out multiple-compartment reporting

Coding for knee procedures performed in multiple compartments can get complicated when you don't know when to append modifier -59. Follow these three expert tips to make sure your knee procedure codes are in perfect sync.
1. Separate compartments earn separate codes.
There are three compartments of the knee that the physician commonly visualizes during arthroscopic surgery - the medial, lateral and the patellofemoral
compartments. If the physician performs separate procedures in each of these compartments, you should bill for each procedure, says Beth Fulton, CPC, CCS-P, CCP, a coding and auditing supervisor in Winston-Salem, N.C.
 
For example, suppose the physician performed a medial and lateral meniscectomy and an articular cartilage shaving in the patellofemoral compartment. For these procedures, you would report 29880 (Arthroscopy, knee, surgical; with meniscectomy [medial and lateral, including any meniscal shaving]) and 29877 (... debridement/shaving of articular cartilage [chondroplasty]) with modifier -59 (Distinct procedural service), says Annette Grady, CPC, CPC-H, senior healthcare consultant at Eide Bailly LLP in Bismarck, N.D. Because the doctor must perform those procedures in different compartments, be sure to append modifier -59 to the code for the second procedure to communicate to the payer that the procedures involved separate compartments of that knee, Fulton says.
2. Use modifier -59 with care.

Don't automatically append modifier -59 when the physician performed two arthroscopic procedures - make sure they required different compartments.
Incorrect: Suppose the patient receives both a medial meniscectomy and a medial chondroplasty. If you reported both codes and appended modifier -59 to the second, you might get reimbursement from the intermediary because the insurer will assume that the procedures were in different knee compartments. But that is incorrect billing and could be construed as fraud, Fulton says. "Two procedures were performed, and both were performed in the medial compartment, so only one of those can be billed," she says.
Correct: The physician performs an arthroscopic medial meniscectomy and an abrasion arthroplasty in the patellar compartment. In this case, one procedure was in the medial compartment and the other in the patellofemoral, so appending modifier -59 to the second code would be appropriate.
3. Code 29875 is included in most major knee surgeries.
You'll usually only report code 29875 (Arthroscopy, knee, surgical; synovectomy, limited [e.g., plica or shelf resection] [separate procedure]) if that is all the physician is doing. Because the work for this code is included in the major knee procedures, "you're not going to be able to bill that code if [the physician] does something else," Fulton says.

- Published on 2005-05-17