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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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EHR Technical Assistance Is Essential, Not a Luxury

Electronic health records (EHRs) are expensive to implement, and this is particularly true of enterprise-wide EHRs. But despite the high prices already paid, adequate EHR support often is not covered in the contract. If an EHR is dropped off at the practice like a new laptop, with nothing more than basic instructions and a “Good luck” wish, you are not likely to realize the full potential of the system. The “standard” support may not be adequate for implementation, let alone ongoing use.

For example, the study “Small Physician Practices In New York Needed Sustained Help To Realize Gains In Quality From Use of Electronic Health Records,” published in Health Affairs, “evaluated the early effects on quality of the Primary Care Information Project, which provides subsidized EHRs and technical assistance to primary care practices in underserved neighborhoods in New York City.” As stated in the study abstract, the authors concluded, “It took sustained exposure on the part of these practices and technical assistance to them before they demonstrated improvement on measures of care most likely to be affected by the use of electronic health records, such as cancer screenings and care for patients with diabetes.”

Sometimes, the issue is the quality of the support personnel. If this is the case, the hospital/medical practice should have the contractual option of changing personnel. More often, however, the necessary support hasn’t be contracted, in the first place. It is assumed that the hospital/practice personnel will have the time/expertise to pick up all of the implementation slack not provided by the EHR personnel. But as implementation problems erupt, enormous amounts of hospital/practice personnel time are burned to get things working, often without anything resembling best practice results.

The “best practice” approach must involve contracting for adequate support from the EHR vendor, as well as preparation for the time and effort required by personnel.

August 20th, 2014

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Hacks Breach Hospital Chain’s PHI Data

What is believed to be Chinese hackers seeking intellectual property instead hacked non-medical identification data of 4.5 million patients visiting physicians associated with Community Health Systems hospitals, the chain said in an SEC statement. The chain, which boasts affiliation with 206 hospitals in 29 states, says it believes the hackers were looking for medical device and equipment development data.

The company says personal health information (PHI) data stolen included patients’ names, Social Security numbers, physical addresses, birthdays, and telephone numbers.They did not steal information related to patients’ medical histories, clinical operations, or credit cards, and the FBI says it is working with Community Health Systems to identify the hackers and protect the data.

As a HIPAA violation, the company said in its SEC statement, the offending malware has been eliminated from its computer systems. It plans to offer identity theft protection to the 4.5 million victims of the breach.

Hacks of PHI comprise less than 10 percent of breaches reported to the federal Office for Civil Rights at the Department of Health & Human Services, but they can be significant and costly. In 2012, the Utah Department of Technology Services’ servers were breached, exposing three quarters of a million records of Utah Medicaid and Children’s Health Insurance program beneficiaries; the Salt Lake Tribune reported the state paid $3.4 million directly and forced another $5.6 million of improvements to prohibit another breach.



August 18th, 2014

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Weigh in on Proposed MPFS

If you want to weigh in on the next few years’ physician fee schedule, do it before September 2.

On July 3, the Centers for Medicare & Medicaid Services (CMS) placed the 2015 Physician Fee Schedule proposed rule on display in the Federal Register for comment. This proposed rule includes provisions for relative value units (RVUs) for 2015 and other Medicare Part B payment policies to ensure payment systems are updated to reflect changes in medical practice and the relative value of services.

The proposed rule also includes new provisions and updates, including policies related to:

The proposed requirements for PQRS focus primarily on the 2017 PQRS payment adjustment, which is based on quality measures reporting data from the reporting period January 1, 2015 to December 31, 2015.

CMS is accepting comments on the proposed rule until 5  p.m., September 22. Instructions for submitting comments on this proposed rule are available at

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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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