“Bundling.” It’s an innocent-looking word that can cause you giant headaches. That’s especially so for bundling for arthroscopic procedures—whether for knee, shoulder, ankle, or another area. And it’s easy to get lost in the continuous edits dictating which codes can and cannot be bundled.
Important: Even if the documentation supports the use of several codes, you can’t necessarily report them all together, warns advanced coding specialist Margie Scalley Vaught in her live audio conference on arthroscopic procedures codes. That’s nothing new, just a reminder to look carefully at each new set of edits from the National Correct Coding Initiative (NCCI). Here are a few key edits from NCCI’s last update on January 1, 2018, and how to handle common bundling questions.
Surgical Arthroscopy: What’s Separately Reportable?
With certain patient conditions, a diagnostic arthroscopy can become a surgical arthroscopy. At other times, the findings of a “scouting” (diagnostic) arthroscopy may lead the physician to decide to perform an open procedure. So, when can you report which procedure?
Use the following tips from the NCCI edits as a general guide:
- A diagnostic arthroscopy—i.e., where the arthroscope “scopes out” the area to see if a more extensive procedure is required—is already part of a surgical arthroscopy, meaning that, if both procedures were performed at the same encounter, only the surgical arthroscopy can be reported.
- If an arthroscopic procedure turns into an open procedure, you can only report the open procedure.
- Scouting procedures—where a physician goes in to do a quick check—can get tricky. If the medical record indicates that the scouting procedure really was just a quick check, you are not to report the scouting procedure. If, however, the results of the scouting procedure led to a decision to perform an open procedure, you may be able to report both.
Modifier 58: To properly report both a scouting arthroscopic procedure and an open procedure, use modifier 58, Staged or related procedure or service by the same physician during the post-operative period. Using modifier 58 is appropriate in this case because the scouting procedure was planned and the open procedure was related and more extensive than what was originally planned.
Beware: However, when using modifier 58, be sure that the documentation indicates the medical necessity of each procedure, and that the same physician performed both.
Knee Procedures: Caution with Modifier 59
If you’ve tried bundling synovectomy code CPT® 29875 with a more extensive knee arthroscopy code such as those in the 29880-29889 range, chances are very good payers have denied these claims, at least if you’re trying to bill for procedures on the same knee. The same goes for the second synovectomy code 29876 as well as 29874 for surgical knee arthroscopy for removal of loose/foreign bodies.
Why? The work associated with CPT® 29874, 29875, and 29876 are inclusive of these more extensive arthroscopic procedures, according to the American Academy of Orthopedic Surgeons (AAOS), so you should report 29874, 29875, or 29876 only. Of course, if you’re billing for two separate procedures, one on each knee, these edits would not apply.
When you’ve reported 29874, 29875, or 29876 with a more extensive knee arthroscopic procedure in the past, you may have even tried attaching modifier 59, Distinct procedural service. Did you receive a denial? Unfortunately, even with -59, synovectomy code CPT® 29875—as well as 29874 and 29876—are still inclusive of the other procedures and so both cannot be reported.
Bundle with care: When the documentation supports two codes that can’t be bundled, it’s extra easy to make a coding misstep. But by knowing the edits inside and out—and having reference tools at hand—you’ll know which codes are inclusive and report only those, every time.
Keep Calm and Bundle On – The Right Way
We know you’re busy absorbing the newest ICD-10-CM and CPT® codes, so the last thing you need is to waste time stressing over NCCI edits. With Vaught’s presentation, discover strategies and solutions for ensuring that your arthroscopy coding and billing is based on your payer/carrier contracts. And don’t stop there: Learn how to be proactive with NCCI edits to prevent problems before they pop up. Get the tools you need to up your confidence and code with ease!
