29826? 29822? 29825? Which one(s)??

betsycpcp

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I work for a payer--ASC is billing one code (29822), the surgeon billed another (29826), and the precert was for yet another (authorized for lysis of adhesions done during previously auth manipulation under anesthesia-29825)! Here's the op report:

"The patient was brought to the operating reoom where she was placed under general laryngeal mask anesthesia. She was then placed in a beachchair position and maintained in that position with a T-max chair and spider arm attachment. Gentle manipulation of the shoulder was performed through full range of motion. Mechanical lysis of adhesions could be felt. The patient had some residual stiffness particularly with full external rotation and with abduction. It was elected to proceed with video arthroscopy and lysis of adhesions. Following sterile prep and drape, the shoulder was distended with 30 mL of normal saline solution and a posterior arthroscopic portal was established. Examination of the intraarticular structure of the shoulder revealed an intact rotator cuff, normal biceps tendon and anchor. There was marked erythema of the capsule. Examination of the soft tissues revealed intracapsular stuctures had in fact been lysed and no definitive adhesions were identified intra-articularly. The shoulder was then drained of fluid. The subacromial space was penetrated. Here dense hypertrophic synovitis with multiple adhesive bands was identified. Lateral portal was established and using Mitek Vapr, the subacromial space was debrided of scarified tissue and bursal tissue. Repeat manipulation was performed and the restricted movement of the external rotation and adduction was found to be resolved. The shoulder was then drained of fluids. Subacromial space was drained as well. The portals were then closed with 4-0 Monocryl."

The date of service was in 2011 so 29826 was able to be billed by itself, but is that code supported by this report?

The description of the operation at the top of the report is "Manipulation of left shoulder under anesthesia with diagnostic video arthroscopy and lysis of adhesions" which would seem to support 29825, but no one billed with that.

So was the surgeon correct to bill 29826, or was the ASC correct to bill 29822, or should it be something else? Any help would really be appreciated. Thanks!
 

JMeggett

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I work for a payer--ASC is billing one code (29822), the surgeon billed another (29826), and the precert was for yet another (authorized for lysis of adhesions done during previously auth manipulation under anesthesia-29825)! Here's the op report:

"The patient was brought to the operating reoom where she was placed under general laryngeal mask anesthesia. She was then placed in a beachchair position and maintained in that position with a T-max chair and spider arm attachment. Gentle manipulation of the shoulder was performed through full range of motion. Mechanical lysis of adhesions could be felt. The patient had some residual stiffness particularly with full external rotation and with abduction. It was elected to proceed with video arthroscopy and lysis of adhesions. Following sterile prep and drape, the shoulder was distended with 30 mL of normal saline solution and a posterior arthroscopic portal was established. Examination of the intraarticular structure of the shoulder revealed an intact rotator cuff, normal biceps tendon and anchor. There was marked erythema of the capsule. Examination of the soft tissues revealed intracapsular stuctures had in fact been lysed and no definitive adhesions were identified intra-articularly. The shoulder was then drained of fluid. The subacromial space was penetrated. Here dense hypertrophic synovitis with multiple adhesive bands was identified. Lateral portal was established and using Mitek Vapr, the subacromial space was debrided of scarified tissue and bursal tissue. Repeat manipulation was performed and the restricted movement of the external rotation and adduction was found to be resolved. The shoulder was then drained of fluids. Subacromial space was drained as well. The portals were then closed with 4-0 Monocryl."

The date of service was in 2011 so 29826 was able to be billed by itself, but is that code supported by this report?

The description of the operation at the top of the report is "Manipulation of left shoulder under anesthesia with diagnostic video arthroscopy and lysis of adhesions" which would seem to support 29825, but no one billed with that.

So was the surgeon correct to bill 29826, or was the ASC correct to bill 29822, or should it be something else? Any help would really be appreciated. Thanks!
I definitely would have billed 29825 for this. 29822 is bundled with 29825 per CCI, otherwise I would bill that too. I do not feel this qualifies for 29826 as no partial acromioplasty was documented.
Jenna, CPC
 
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