Coding Category

Surgery Arthroscopy Includes Debridement (with an Important Exception)

In most cases, per CMS rules, surgical arthroscopy will include arthroscopic debridement of the same joint; therefore, you may not report the debridement separately.

For example, you should not separately report 29874 Arthroscopy, knee, surgical; for removal of loose body or foreign body (eg, osteochondritis dissecans fragmentation, chondral fragmentation) and 29877 Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)with other knee arthroscopy codes (29866- 29889), for Medicare payers.

There is an exception to this general rule: You may report 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 with other knee arthroscopy codes, for Medicare payers, but only if the removal or debridement occurs in a different compartment of the knee from the primary surgical service. Per Chapter 4 of the National Correct Coding Initiative (NCCI) Policy Manual:

Since CPT codes 29880 and 29881 (Surgical knee arthroscopy with meniscectomy including debridement/shaving of articular cartilage of same or separate compartment(s)) include debridement/shaving of articular cartilage of any compartment, HCPCS code G0289 may be reported with CPT codes 29880 or 29881 only if reported for removal of a loose body or foreign body from a different compartment of the same knee. HCPCS code G0289 should not be reported for removal of a loose body or foreign body or debridement/shaving of articular cartilage from the same compartment as another knee arthroscopic procedure.

When removal of a loose body or foreign body occurs in the same compartment of the same knee as another procedure, you may not report the procedure separately.

August 21st, 2014

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Two New “K” Codes in Effect Oct. 1

Durable medical equipment (DME) suppliers will soon have two new “K” codes (K0901 and K0902) for reporting off-the-shelf (OTS) prefabricated single and double upright knee orthoses to Medicare.

To identify prefabricated single and double upright knee orthoses that are furnished in a variety of standard sizes and do not require the skills of an expert to measure and fit to the individual, the following OTS codes will be added to the HCPCS Level II code set, effective October 1, 2014:

K0901 - Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf

K0902 - Knee orthosis (KO), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf

The Centers for Medicare & Medicaid Services (CMS) defines the term “minimal self-adjustment” to mean an adjustment that the beneficiary, caretaker for the beneficiary, or supplier of the device can perform and that does not require the services of a certified orthotist or an individual who has specialized training.

You can download the complete list of OTS orthotics HCPCS Level II codes from the CMS website.

Sources: MLN Matters® Number: MM8839; CMS Transmittal  3016, CR8839

August 13th, 2014

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CMS Proposes Coverage of Colorectal Cancer DNA Test

An easier colorectal screening method may be reimbursed by Centers for Medicare & Medicaid Services (CMS) related programs if support for a proposed decision memo succeeds. CMS is proposing coverage of the Cologuard™ DNA stool test once every three years for beneficiaries who meet particular criteria.

Cologuard was recently approved by the Food and Drug Administration (FDA). Research supports the test, which detects molecular markers of the altered DNA contained in cells shed by colorectal cancer and pre-malignant colorectal epithelial neoplasia. The test identifies three specific markers, the first being epigenetic changes, the second detecting specific point mutations, and the third identifying human fecal hemoglobin.

The test will be a relief for most adults between ages 50 and 85 years. Additional criteria beyond age include:

  • Asymptomatic (No signs or symptoms of colorectal disease including gastrointestinal pain, blood in stool, positive guaiac fecal occult blot test or fecal immunochemical test.)
  • Average risk (No history of adenomatous polyps, colorectal cancer, or inflammatory bowel disease (IBD), Crohn’s disease, ulcerative colitis. No family history of colorectal cancer or adnomatous polyp, familial adenomatous polyposis, or hereditary nopolyposis colorectal cancer).

CMS seeks comments on the proposed decision by September 11.

August 11th, 2014

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What To Do When Your Patient Is a “Poor Historian”

Clear and comprehensive documentation is a critical element in getting claims paid. You hear that advice day in and day out. So what do you do when the provider is unable to obtain a critical component of documentation from a patient? The answer isn’t as tricky as you might think.

When a provider is unable to obtain certain medical information, he or she should clearly document in the record:

  • The components that were unobtainable (for example, the history of present illness (HPI); and
  • Circumstances that precluded obtaining the specific documentation. For example, “The patient was unconscious.” Or, “The patient was a ‘poor historian’ due to advanced dementia.”

Before giving up the ship, however, the provider should attempt to obtain the information from another source, such as a family member, spouse, medical record, etc. If these sources were unable to supply the missing information, the attempt should be documented as well. For example:

  • “A family member was contacted, but unable to provide additional information.” Or,
  • “The medical record did not contain the needed information.”

If, at a later time, the patient or some other source is able to supply the missing information, the provider may add an addendum to the record to fill in the missing blanks that support medical necessity for the provided services.

Resource: The Centers for Medicare & Medicaid Services 1995 and 1997 Documentation Guidelines for Evaluation and Management Services

August 8th, 2014

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ICD-10 Implementation Strategies: Assessing Timelines

Now that we have an official compliance date on ICD-10, it is time to sit down and take a look at where your practice/organization is in its ICD-10 planning. If you had slowed down in your preparations, now is the time to ramp things back up. Assessments should include: which employees already received some education, which ones still need it, where the practice is with vendors, clinical documentation improvement efforts, and budget needs.

August 6th, 2014

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