Orthopedic Coding Rules: Master The 'multiple Scope' Rule

By Author: Angela Martin
Total Articles: 205
Comment this article

If your orthopedist carries out several procedures during a knee arthroscopy on the same patient on the same day, you will need to understand the multiple-scope rule to determine which procedures you can actually claim and get the payments too.


Vital orthopedic exception: Remember that the multiple-scope rule applies mainly to shoulder and knee procedures in the orthopedic practice; however it also affects those of the elbow, wrist and hip. On the contrary, it doesn't apply to ankle or metacarpophalangeal (MCP) arthroscopy, and it does not affect arthroscopically aided procedures (29851, 29855-29856, 29888-29889 and 29892).


Follow these expert-approved tips to clinch your coding every time

1. Look to CPT for scope 'families'


Prior to worrying about how to apply the multiple-endoscopy rule, you should first know why and when it applies.


The multiple-endoscopy rule is Medicare's method to avoid paying twice (or more) for 'inclusive' services by reimbursing only a portion of any scope carried out at the same time as another ...
... scope of the same basic type.



2. Always include the 'base' procedure


Let us assume that the doctor has carried out a diagnostic shoulder arthroscopy (29805) plus shoulder arthroscopy for repair of SLAP lesion (29807). How does the multiple-scope rule apply?


Remember that family codes always include the work involved in the base code, and a surgical scope always includes the diagnostic scope of the same type. As such, you would report only 29807 in this case.


What about diagnostic shoulder arthroscopy followed by arthroscopic limited debridement? Once more, you should report only the more extensive procedure - in this case, 29822 (Arthroscopy, shoulder, surgical; debridement, limited).

3. Bill both scopes if there's no base procedure


If the surgeon carries out two scopes in the same family, neither of which is the base procedure, you should go for both codes. As such, if your orthopedist carries out shoulder arthroscopy with foreign-body removal (29819) followed by shoulder arthroscopy for complete synovectomy, you would submit both 29819 and 29821 ( synovectomy, complete).

4. Watch your reimbursement


Under the multiple-scope rule, Medicare will pay the entire fee schedule amount only for the highest-valued scope in a given code family during the same operative session. Medicare carriers will reimburse any additional scopes in the same family by subtracting the value of the base scope in that family and paying the difference.


For more details on this and for other orthopedic coding updates, sign up for an audio conference and stay informed.