Orthopedic Coding Alert
Appeal When Payers Don't Recognize -59
Question: I have difficulty collecting for arthroscopy of the glenohumeral joint (29822) when I also perform arthroscopic shoulder decompression (29826) at the same session. How can we collect for these procedures? Answer: Because the National Correct Coding Initiative (NCCI) 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 NCCI edit.
Tennessee Subscriber
Some 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.
Orthopedic Coding Alert
- Refresh Your Fracture Care Coding With Expert Answers to 4 FAQs
Modifiers can be the key to payment Do you know your Galeazzi fracture from your [...] - RVU Update:
Expect an 8 Percent Raise for G0289 Charges
2005 Fee Schedule offers some gains, but a few big losses, too The good news: [...] - Chart the Changes to the 2005 RVUs That Will Affect Your Bottom Line
Medicare's 2005 Physician Fee Schedule may impact your reimbursement more than you expect The new [...] - News You Can Use:
New Meniscal Transplant Code Pays Nearly $1,700 in 2005
But new wound VAC codes won't bring in any reimbursement Medicare's 2005 Physician Fee Schedule [...] - You Be the Coder:
Do Aircasts Differ From Splints?
Question: Does an aircast qualify as a splint?
California Subscriber
Answer: No. Placing a patient [...] - Reader Questions:
Choose Unlisted for Peroneal Sheath Aspiration
Question: Our orthopedist entered the peroneal sheath and aspirated fluid. I can't determine whether to [...] - Reader Questions:
Appeal When Payers Don't Recognize -59
Question: I have difficulty collecting for arthroscopy of the glenohumeral joint (29822) when I also [...] - Reader Questions:
Only Bill G0289 to Private Payers When Directed
Question: We performed a right knee medial meniscectomy, along with chondroplasty of the patella and [...] - Reader Questions:
Combine ED Visit With Admission
Question: When our orthopedist admits a patient to the hospital after-hours from the emergency department [...] - Reader Questions:
Avoid 26535 for the Toe
Question: Is code 26535 limited strictly to the hand, or can we use it for [...]
