Q&A G0289 & 29877 REMOVAL OF LOOSE BODIES & ARTHROSCOPY

[shavana]

INSURANCE: UHC
CPT : G0289
DOS: 10/30/13
QUESTION: BECAUSE UHC FOLLOWS MEDICARE GUIDELINES, I HAVE CHOOSEN TO BILL G0289 FOR THE REMOVAL OF THE LOOSE BODIES. CPT GUIDELINES STATES WHEN G0289 IS PERFORMED IN THE SAME COMPARTMENT WITH 29877 IT IS NOT SEPARATELY REIMBURSABLE. HOWEVER, IF THE REMOVAL OF LOOSE BODIES IS GREATER THAN 5MM OR IT 'S IN A DIFFERENT COMPARTMENT, IT MAY GET PAID. I HAVE APPEALED TWICE WITH UHC AND THEY FAIL TO RECOGNIZE THAT THESE TWO SCENARIOS CAN ALLOW PAYMENT. THEY KEEP DENYING , STATING THE PROCEDURES WERE DONE IN THE SAME COMPARTMENT.

HAS ANYONE HAD DIFFICULTIES WITH GETTING G0289 PAID WHEN THE LOOSE BODIES ARE GREATER THAN 5MM. THE OPERATIVE NOTES SUPPORTED THE REMOVAL OF LOOSE BODIES GREATER THAN 5 MM AND REVIEWED BY OUR CODER.

 

[Ruth Sheets]

This topic was covered by Laureen during the April 2014 Q&A Webinar. She emphasized the need to have very clear documentation indicating that there was work done in TWO compartments to support using both 29877 for the first compartment work and G0289 for the 2nd compartment work in Medicare cases. Join the CCO Club if you would like to have the full transcript, answer sheets, access to the recording, and a chance to earn an AAPC CEU. You will also get access to all the available monthly Q&A webinar resources when you join the CCO Club!