29823 AAOS has convinced CMS to delete the NCCI edit effective July 1, 2016

Pillow1

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29824 Arthroscopy, shoulder, surgical, distal claviculectomy including distal articular surface (Mumford procedure)
29827 ..with Rotator cuff repair
29828 biceps tenodesis

Should I bill the 29823 with or without the 59 modifier to receive reimbursement for the Arthroscopy, shoulder, surgical,debridement, extensive)?

per the AAPC HEALTHCARE Business monthly June 2016 edition CMS has deleted the edit.

Thanks for any feedback!!

Denise Gilrane-Pillow, CPB
 

CodingKing

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29824 Arthroscopy, shoulder, surgical, distal claviculectomy including distal articular surface (Mumford procedure)
29827 ..with Rotator cuff repair
29828 biceps tenodesis

Should I bill the 29823 with or without the 59 modifier to receive reimbursement for the Arthroscopy, shoulder, surgical,debridement, extensive)?

per the AAPC HEALTHCARE Business monthly June 2016 edition CMS has deleted the edit.

Thanks for any feedback!!

Denise Gilrane-Pillow, CPB

You shouldn't need the modifier 59 for date of service 7/1/16 and future but I don't know how quickly payers update their systems edits or if they have their own custom Edits
 

shecodes

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I'd be cautious rushing into this one. Although they are removing the PTP edits, they have not revised the written guidelines. See below. This email was received from Karen Zupko.

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NCCI Edit Change for 29823 - Time To Celebrate, or Not?

The word is out. In its planned July 1, 2016 NCCI procedure-to-procedure edits, CMS will reportedly remove an edit that has historically limited physician reporting of arthroscopic debridement code 29823. The edits being removed apply when 29823 is performed secondary to three other shoulder arthroscopy procedures: 29827 (rotator cuff repair), 29824 (distal clavicle resection), and 29828 (biceps tenodesis). While this is an important change that resulted after tremendous effort by the American Academy of Orthopaedic Surgeons (AAOS) and the Arthroscopy Association of North America (AANA), more information is needed from NCCI and CMS before we can jump for joy.

Remember, CMS's NCCI system has two parts: procedure-to-procedure (PTP) edits and narrative guidelines. The procedure-to-procedure edits were developed first and are updated quarterly. The narrative guidelines are only updated annually, in January, and are designed to apply to multiple code combinations. Changes to a PTP edit do not automatically revise a narrative guideline, thus both factors must be considered when coding.

A 2016 NCCI narrative guideline found in Chapter IV, Section E, Paragraph 6 states: "With the exception of knee arthroscopy, (29877, 29874, G0289) debridement should not be reported with another surgical arthroscopy procedure, same joint, same encounter." As long as this narrative guideline is present, it is not appropriate to report 29823 for debridement in the same shoulder when 29827, 29824, or 29828 are performed, even if there is no PTP edit between the codes.

NCCI has reportedly not provided AAOS representatives with any information other than that the edits will be deleted effective July 1.

What is KZA's advice? For non-Medicare plans, report 29823 when it is appropriately documented, even when it is performed in the same shoulder as these other procedures. That's because the AAOS has always classified debridement as a separately reportable procedure under its Global Service Data guidelines.

For Medicare plans, until NCCI issues clarification or formally removes this narrative guideline, we must assume it still applies. If you receive alternate instruction from your Medicare MAC, report it to KZA, and we'll share that information with our orthopaedic community.
 
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