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Disagree with provider coding 29876 & G0289

Happy Friday all!!

Hoping someone can help with this one. I am not agreeing with my provider on this one.

Op Report states:

"Standard arthroscopy portals were performed, anteromedial, anterolateral and superomedial.

A fair amount of synovitis was noted throughout the entire knee joint and synovectomy was performed.

After synovectomy was performed I was able to visualize all the compartments of the knee. Patellofemoral joint was within normal limits.

Medial compartment of knee shows a tear of the posterior horn of the medial meniscus, partial meniscectomy was performed. Also a tear of the anterior horn of the medial meniscus was seen and partial meniscectomy was performed.

In the intercondylar notch the anterior cruciate ligament was intact. In the lateral compartment of the knee the radial tear of the free edge of the body of the meniscus was seen and partial meniscectomy was performed until stable edges were seen. All debris was extracted and portals closed."

Physician wants to bill 29876 and G0289. I think only 29876. Any thoughts?

Thank you!!!

Medical Billing and Coding Forum

Modifier 59 for duplicate service- no mue, no cci edit. I disagree.

Would like everyone’s opinion with this situation. I have a series of CPT codes reported on the same encounter, same patient, ect. There are duplicate service codes reported for one service. The MUE is 2, and there are no NCCI edits when coded with the other services on the same claim.
A colleague of mine is adamant that we should report that code, on two different lines, with a modifier XS on the second line.
My argument is, that CPT code, has a MUE of 2, is not subject to the multiple payment policy indicator of 2, nor the payment policy indicator of 3, and has no bundled edits, therefore, we should be reporting that code, one one line, with a total unit of 2 in lieu of reporting the XS modifier, and splitting out the code.

Any takers on this? I am fully aware of Medicare’s guidelines with regards to the 59 modifier, but I do not see anything that can back up my analysis of this stating we should not be reporting this way, because it is improper coding, and can trigger an audit.

Medical Billing and Coding Forum