Orthopedic Coding Alert

Question:

Tennessee Subscriber

Because the Correct Coding Initiative (CCI) includes debridement (29822, Arthroscopy, shoulder, surgical; debridement, limited) as an edit with 29826 (... decompression of subacromial space with partial acromioplasty, with or without coracoacromial release), insurers won't reimburse you for both services unless you append modifier 59 (Distinct procedural service) to 29822. Because your surgeon performed a procedure in the glenohumeral joint in addition to a procedure in the subacromial space, you are justified in appending modifier 59 to separate the CCI edit.

Warning: Most payers, however, do not recognize modifier 59. If your insurer falls into this group, you should appeal the denial with a short letter describing the procedure, noting the fact that you addressed two separate areas, along with a copy of your operative report. Also, you may want to attach the CPT Assistant article that says you can code 29822 in addition to 29826.