Orthopedic Coding Alert

Question: An orthopedist in my practice arthroscopically repaired a rotator cuff on the left shoulder, and then aspirated the right shoulder. I used the LT and RT modifiers, of course, to indicate the doctor worked on different sites, but the insurer denied the claim anyway. How can I get reimbursement for the two separate procedures?

Vermont Subscriber

Answer: For these procedures, you can’t stop with modifiers LT (Left side) and RT (Right side). You’ll also need modifier 59 (Distinct procedural service). To report both the arthroscopy and aspiration, you should use 29827-LT (Arthroscopy, shoulder, surgical; with rotator cuff repair) and 20610-59-RT (Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]).

Although the LT and RT modifiers indicate that your orthopedist treated different shoulders, modifier 59 definitively shows that the two procedures were separate in this case. Typically, 29827 includes the work associated with an aspiration. In this case, modifier 59 will help override the Correct Coding Initiative (CCI) edit that’s probably triggering the denial, and the LT and RT modifiers will show that the procedures were performed on different shoulders.