Q&A: Applying modifier -59 for knee arthroscopies

Q: Based on CPT Assistant, CPT code 29874 (knee arthroscopy with removal of loose/foreign body) may be reported with modifier -59 (distinct procedural service) if performed in a separate compartment from procedures 29875-29881. This advice conflicts with NCCI edits between codes 29874 and 29880 (knee arthroscopy with meniscectomy [medial and lateral, including any meniscal shaving] including debridement/shaving of articular cartilage, same or separate compartment[s] when performed). Do the NCCI edits override the advice in CPT Assistant?

A: This is a case of CMS providing specific reporting guidance for a procedure. CPT code 29880 is defined as “same or separate compartments.” CMS has defined that they will not cover the removal of a loose body in the same compartment of the knee when a meniscectomy is performed. This is part of the procedure; you have to remove the loose bodies while in the compartment where the meniscectomy is performed. They do provide HCPCS code G0289 for removal of a loose body in a different compartment of the same knee. While other payers may accept 29874-59 per CPT guidelines, CMS considers this part of the other procedure. NCCI Manual, Chapter 4, states:

6. CPT codes 29874 (Surgical knee arthroscopy for removal of loose body or foreign body) and 29877 (Surgical knee arthroscopy for debridement/shaving of articular cartilage) should not be reported with other knee arthroscopy codes (29866-29889). With two exceptions HCPCS code G0289 (Surgical knee arthroscopy for removal of loose body, foreign body, debridement/shaving of articular cartilage at the time of other surgical knee arthroscopy in a different compartment of the same knee) may be reported with other knee arthroscopy codes. Since CPT codes 29880 and 29881 (Surgical knee arthroscopy with meniscectomy including debridement/shaving of articular cartilage of same or separate compartment(s)) include debridement/shaving of articular cartilage of any compartment, HCPCS code G0289 may be reported with CPT codes 29880 or 29881 only if reported for removal of a loose body or foreign body from a different compartment of the same knee. HCPCS code G0289 should not be reported for removal of a loose body or foreign body or debridement/shaving of articular cartilage from the same compartment as another knee arthroscopic procedure. This paragraph was relocated here from Section H (General Policy Statements), paragraph 11 in 2014.

Editor’s note: Denise Williams, RN, COC, and Valerie A. Rinkle, MPA, answered this question on the HCPro webinar “NCCIs and MUEs: Solving Claims Edits.”

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