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Orthopedic Coding Alert

READER QUESTIONS:

Expect Less Payment for G0289

Question: If our surgeon performs separate compartment chondroplasty (G0289) with meniscectomy (29881), can we collect the full chondroplasty fee, or will Medicare subject G0289 to the multiple-procedure discount?


Tennessee Subscriber
Answer: The answer depends on your date of service. In the past, CMS did not subject G0289 (Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage [chondroplasty] at the time of other surgical knee arthroscopy in a different compartment of the same knee) to the multiple-procedure rule.

Most orthopedic coders took this to mean that the code's value was already low because CMS knew that surgical practices would report G0289 only with a meniscectomy code (such as 29881, Arthroscopy, knee, surgical; with meniscectomy [medial OR lateral, including any meniscal shaving]).

Therefore, coders and payers treated G0289 like an add-on code, which meant that no multiple-procedure reduction applied.

However, CMS recently released Change Request 4031 with an implementation date of Oct. 3, 2005, which changes G0289's multiple-procedure indicator from -0- (which meant that Medicare payers did not subject the code to the multiple-procedure rule) to -2.-

This means that the multiple-procedure discount of 50 percent applies to the code. Therefore, you can now expect half of the reimbursement than before for the G0289 claims that you submit to Medicare carriers. You can read Medicare's full transmittal at the CMS site www.cms.hhs.gov/manuals/pm_trans/R672CP.pdf.


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