NCCI Guidelines: An internal audit of knee arthroscopy procedures has identified
ID: 3521254 • Letter: N
Question
NCCI Guidelines: An internal audit of knee arthroscopy procedures has identified the following: 29880 and 29876 are being coded together for the same knee
1. Based on NCCI edits, elaborate on the appropriateness of this coding practice.
2. Develop a process to ensure that NCCI arthroscopy guidelines are followed.
500 words please.
References: Castro, A.B. and E. Forrestal. 2015. Principles of Healthcare Reimbursement, 5th edition. Chicago,:AHIMA Centers for Medicare and Medicaid Services (2015). NCCI Policy Manual for Medicare Services. Link: https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html
Hazelwood, A. and C. Venable. 2016. Reimbursement Methodologies. Chapter 7 in Health Information Management: Concepts, Principles, and Practice, 5th ed. Oachs, P. and A. Watters, eds. Chicago: AHIMA
Explanation / Answer
1.The CPT code 29880 stands for the surgery performed to the knee arthroscopically with meniscectomy of medial and lateral compartments and includes meniscal shaving which comprises debridement or shaving of articular cartilage of the same or separate compartment[s].
CPT code 29876 is coded for major synovectomy arthroscopically when performed on both compartments of the knee.For reporting 29876 in addition to another arthroscopic knee procedure, documentation must provide evidence of pathologic synovial disease. CPT: If pathologic synovial disease is present, 29876 may be reported with another arthroscopic knee procedure, even if it occurs in the same compartment – excluding procedures for removal of loose/foreign body or chondroplasty.
2.The Reimbursement is not allowed because the code description for code 29876 shows the procedure has to be performed on 2 or more compartments to be billed while the 29876 is reported with any pathological synovial disease. Because code 29880 was performed in the same compartments as 29876, the documentation does not support billing code 29876 with modifier 59. As a result, reimbursement is not recommended.
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