April 28, 2016
Since January we have not been able to get code 29875-59 paid. All of our claims are coming back bundled to code 29880. I have submitted the operative reports showing that it was a separate procedure, performed in a separate compartment however our appeals are also being denied. How do you recommend getting the claims processed correctly?
Thanks for your inquiry. I think you are misinterpreting the intention of the (separate procedure) designation in the CPT code descriptor. In the surgery guidelines of CPT, the instructions state that codes designated as “separate procedure” should not be reported in addition to the code for the total procedure or service of which it is considered an integral component. A limited synovectomy would be considered an integral component of any arthroscopic procedure done on the same knee. We would not recommend reporting these codes together if performed on the ipsilateral knee.
*This response is based on the best information available as of 04/28/16.