July 14, 2017
1 min read

Understand CMS G codes, bundling packages for maximal payments

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This issue of Orthopedics Today includes a new orthopedic coding column by William R. Beach, MD, one of the publication’s Editorial Board members. As orthopedic procedures and the various ways to code them continue to become more complex, the information in this column will help improve the orthopedic surgeon’s understanding of all types of codes and bundling packages for maximal payments.

Anthony A. Romeo, MD
Chief Medical Editor

William R. Beach, MD
William R. Beach

Often, CMS and private insurers have different payment rules and bundling packages. CMS created and owns the National Correct Coding Initiative (NCCI), which makes bundling decisions and creates bundling packages for CMS. Private insurers often use a mixture of NCCI and proprietary payment systems, however providers and billing/coding specialists may not realize these differences exist and there are available opportunities from knowing those differences.

Take knee arthroscopy, for example. If an arthroscopic partial medial or lateral meniscectomy is performed, the appropriate CPT code is 29881. If an arthroscopic medial chondroplasty (29877) or arthroscopic removal of a loose body (29874) in the medial compartment is also performed, the chondroplasty or loose body removal cannot be listed or charged. Thus, payment would only be received for the meniscectomy. Private payers will not allow payment for a chondroplasty or removal of a loose body in any compartment of the knee. CMS also will not pay for 29877 or 29874, but it has ruled the knee has three compartments. Therefore, CMS, through NCCI and Current Procedural Terminology, has created G codes to address special coding circumstances. CMS uses the G code G0289 and will pay for chondroplasty and removal of a loose body(s) in the other two compartments of the knee (lateral and patellofemoral).

Disclosure: Beach reports he receives royalties and consulting fees from Arthrex.