Wiki 29826 and worker's compensation


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Hope I can get some help with this one. We're having trouble getting paid for 29826 with arthroscopic rotator cuff repair for Worker's Comp carriers that follow NCCI guidelines. 29827 is not on the OMFS schedule so we submit 29909 with a comparable code of 23410 or 23412 depending on whether or not the rotator tear is acute or chronic.

Per NCCI, 29826 bundles with 23410 and 23412 and CMS is not following the AMA or AAOS in using 29822 or 29823 for subacromial decompression.

We're appealing the denials and pointing out that 23410 and 23412 are comparable codes being used for valuation, but haven't been very successful in getting paid.

Anyone else dealing with this issue and how are you handling it?


Wow! I cannot believe that 29827 isn't on the fee schedule. Your workers' comp carrier needs to get with the program. I would not use an open code if the repair was done arthroscopically.

Everything that I've seen does not allow 29826 with either 23410 or 23412. We don't bill it if the surgeon does an open or mini-open procedure.

Do you have an oversight group at the State level that governs workers' comp? I would put this issue (of 29827) to them.
work comp is a non-HIPAA entity and therefore does not have to play by the rules everyone else does. You need to know what year of CPT your work comp is using and also what year version of CCI edits. The code you are being denied on may not have existed in the year they use and that is why it is being denied. as far as oversite goes, work comp comes under the dept of labor. However each state sets their own rules for their work comp system. You need a provider manual for your state wrk comp, these are usually found on line but you have hunt for it.
I hate to change the subject, but additionally, can someone confirm or deny the idea that 29822 may be billed with 23410 or 23412 instead of 29826? I was informed that was allowable, but have had reservations. There are many instances in which our surgeon performs the mini-open, but first, through a different port, will perform either or both the subacromial decompression, and/or the bursectomy.

Thanks for any feedback!