An orthopedist carries out several procedures during a knee arthroscopy on the same patient on the same day. Here, you will need to understand the multiple-scope rule to determine which procedures you can actually claim -- and get the payments for.
Remember:
In the orthopedic practice, the multiple-scope rule applies mainly to shoulder and knee procedures. But then it also affects those of the elbow, wrist and hip. In contrast, it does not apply to ankle or metacarpophalangeal (MCP) arthroscopy; and it doesn't have a say on arthroscopically-aided procedures. That apart, some surgical knee arthroscopies are excluded from the family.
Here are some sure-success tips to seal your coding every time.
Remember:
In the orthopedic practice, the multiple-scope rule applies mainly to shoulder and knee procedures. But then it also affects those of the elbow, wrist and hip. In contrast, it does not apply to ankle or metacarpophalangeal (MCP) arthroscopy; and it doesn't have a say on arthroscopically-aided procedures. That apart, some surgical knee arthroscopies are excluded from the family.
Here are some sure-success tips to seal your coding every time.
You should also include the 'base' procedure. For example, the physician has carried out a diagnostic shoulder arthroscopy (29805) in addition to shoulder arthroscopy for repair of SLAP lesion (29807). As such, how does the multiple-scope rule apply? Family codes always include the work involved in the base code while a surgical scope always includes the diagnostic scope of the same type. Here you would go for only 29807. And as far as diagnostic shoulder arthroscopy followed by arthroscopic limited debridement is concerned, you should once again report only the most extensive procedure. Here you should go for 29822.
Say for instance the surgeon carries out two scopes in the family, neither of which is the base procedure. Here you should go for both codes. Therefore, if your orthopedist carries out shoulder arthroscopy with foreign-body removal (29819) followed by shoulder arthroscopy for complete synovectomy, you would report both 29819 as well as 29821.
Under the multiple-scope rule, Medicare will shell out the entire fee schedule amount only for the highest-valued scope in a given code family during the same operative session. Medicare carriers will pay for any additional scopes in the same family by subtracting the value of the base scope in that family and paying the difference.
Under the multiple-scope rule, Medicare will shell out the entire fee schedule amount only for the highest-valued scope in a given code family during the same operative session. Medicare carriers will pay for any additional scopes in the same family by subtracting the value of the base scope in that family and paying the difference.
