Can You Report Grafts Separately With Rotator Cuff Repairs?
Question: We have an orthopedic surgeon who performs arthroscopic rotator cuff repairs with and without grafts. They claim the work they do when applying the graft is above and beyond the work included in 29827, and that the graft portion should be billed separately. I’ve reviewed documentation for more than two dozen cases, and the documentation doesn’t appear to support more work than the CPT® code. Can grafts be reported separately? Florida Subscriber Answer: When a surgeon uses a patch or implant during arthroscopic rotator cuff augmentation, that work is included in 29827 (Arthroscopy, shoulder, surgical; with rotator cuff repair). The code applies regardless of whether the provider repairs a small tear requiring a single anchor or they need multiple anchors to repair a large tear. In order for the provider to append modifier 22 (Increased procedural services) to receive increased reimbursement, the documentation must show that the case was overly difficult or took considerable time to complete. At the same time, the intraservice time for 29827 is 120 minutes, so unless the surgeon takes significantly longer than that allotted time, receiving increased reimbursement is unlikely. Mike Shaughnessy, BA, CPC, Development Editor, AAPC
