Staying a Step Ahead of Those Constantly Changing CPT Codes

Financial Management

By: Caryl Serbin

Published: 10/10/2007

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Here are 10 things you can do to simplify a process that leaves even professional coders dizzy.


As the president of an ASC coding and billing company, it is a constant challenge just trying to keep up with the ever-changing coding guidelines, not to mention changes imposed by commercial and government insurance carriers. If you run a surgery center, this task is probably exponentially more daunting.

Take, for example, CPT code 29877 [arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chrondoplasty)], when performed with CPT code 29880 [arthroscopy, knee, surgical; with meniscectomy (medial and lateral, including any meniscal shaving)] or 29881 [arthroscopy, knee, surgical; with meniscectomy (medial or lateral, including any meniscal shaving)]. In less than two years, coding guidelines for this procedure have changed several times (see "One Code's Changes").

Are you equipped?
Code 29877 is just one example in the constantly changing world of medical coding; it's tough to keep up with, even if it's your area of expertise. If you're running a surgery center, you've also got to educate other members of your staff and ensure that you comply with state and federal guidelines. Is your center equipped to do all this?

Keep in mind that the danger in not staying up to date on coding guidelines goes beyond losing revenue; you could be targeted by an OIG investigation into fraudulent billing. Here are 10 tips to help you stay on top of the changes and challenges of coding.

1. Standardize it.
Select and stick with one coding system that includes current CPT-4 and ICD-9 coding resources.

2. Hire professionals.
Employ coding specialists with previous experience, education and/or certification. Finding well-educated certified coders is a difficult task. While certification does not necessarily constitute more knowledge, it does represent dedication to the profession. However, there are many knowledgeable medical coders who have not obtained certification.

One Code's Changes

In less than two years, coding guidelines for 29877 [arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chrondoplasty)] have undergone change after change after change.

CCI 8.0
Oct. 2001 through Dec. 2001

29877 could not be billed with procedures 29881 or 29880 when performed in a separate compartment

CCI 8.1
Jan. 2002 through March 2002

29877 could be billed with procedures 29881 or 29880 when performed in a separate compartment by using a modifier

CCI 8.2
April 2002 thru June 2002

29877 could be billed with procedures 29881 or 29880 when performed in a separate compartment by using a modifier

CCI 8.3
July 2002 through Sept. 2002

29877 could not be billed with procedures 29881 or 29880 when performed in a separate compartment. At this point, CMS said that "any claim submitted on or after October 2002 for dates of service January 1, 2002, to September 30, 2002 will deny 29877-59 when performed with 29881, 29880". (Orthopedic Practice Coder, Vol. 2 No. 11 November 2002)

CCI 9.0
Oct. 2002 through Dec. 2002

29877 could not be billed with procedures 29881 or 29880 when performed in a separate compartment.

CCI 9.1
Jan. 2003 through March 2003

29877 could not be billed with procedures 29881 or 29880 when performed in a separate compartment.

January 2003

CMS created HCPCS code G0289 (arthroscopy, knee, surgical, 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) that could be billed in place of 29877 when performed with 29880 or 29881. Guidelines were then developed stating G0289 could be reported once per extra compartment and could only be reported if the physician spent at least 15 minutes in the additional compartment. This time must be documented in the medical records in order to properly bill for it.

April 2003

29877 could be billed with procedures 29881 or 29880 when performed in a separate compartment on all claims for service before March 1, 2003.

April 2003

For claims after March 1, 2003, using HCPCS code G0289, CMS does not require that documentation of spending 15 minutes in an additional compartment be included in the operative note, but does recommend that documentation supports intensity.

3. Apprise staff.
Routinely educate your staff with hand-outs, by talking to them or holding training sessions to ensure they remain up-to-date with guidelines.

4. Follow OIG.
The Office of Inspector General (OIG) requires that you:

  • code only for services or supplies provided;
  • accurately designate diagnosis codes to the highest level of specificity;
  • accurately reflect in your codes the services rendered, the dates of service(s), and the identity of person receiving services;
  • check for the possibility of "unbundling" or "up-coding" using OIG's Correct Coding Initiatives;
  • do not code/bill for non-covered services as covered services;
  • and do not code/bill for supplies or equipment that are not substantiated by the patient's medical record.

5. Know definitions.
Base code selection on standards of medical/surgical practice. For this to be effective, it is essential that the coding description accurately describe what actually transpired at the patient encounter. Because many activities are integral to a procedure, it is impractical and unnecessary to list every event common to all procedures of a similar nature as part of the narrative description for a code. These "generic" activities are assumed to be included as acceptable medical/surgical practice and, while they could be performed separately, they should not be considered as such when a code narrative is defined. Accordingly, all services integral to accomplishing a procedure will be considered included in that procedure and, therefore, will be considered a component and part of the comprehensive code.

6. Monitor compliance.
Appoint one or two staff members to double-check a random sample of cases.

7. Update resources.
Provide current information for your coding staff. There are many specialty-specific subscriptions, updates from commercial and government payers, Internet resources, Internet list-serves, local and national organizations, online training, and seminars and books. In addition, there are many coding resources available that update monthly, bimonthly or quarterly. These updates can alert your coding staff to changes that can drastically affect your revenue.

8. Go digital.
Use computer software that builds and maintains an accurate, reliable and ongoing database of coding references.

9. Be ethical.
Adhere to the Standards of Ethical Coding, outlined by the American Health Information Management Association (www.ahima.org).

10. Get audited.
Perform routine internal audits to ensure compliance and have your coding and billing audited by an outside source at least annually.

Tailor your system
Not every coding and billing system will look alike. But you should keep three things at the fore when implementing your system:

  • Ensure that procedure and diagnostic codes are appropriately assigned for all services provided.
  • Have your coder advise you of changes in documentation requirements and bundling edits, and of new and deleted procedure codes.
  • Keep abreast of compliance regulations.

Remember, whether you choose to use your staff or employ a coding and billing company, medical coding is much more than reading an operative report and selecting procedure and diagnosis codes to be billed.

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