29826 Confusion

HelenU

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If my doctor did a mini open rotator cuff repair, subacromial decompression, arthroscopic Mumford, and debridement of a labral tear in the glenohumeral joint, may I bill out
23412, 29824-51, 29826-59, 29822-59? The order is based on Blue Cross allowables.
Per the dictation, 23412 and 29826 are separate incisions and 29822 is in a different compartment than 29826 and 29824. Or due to the new guidelines, are we to bill only 23412, 29824-51, and 29822-59? I still can't get it straight in my head why we can't bill 23412 and 29826-59. Is there a rule that we can't modify an add-on code w/ -59? Thank you to anyone who can help me understand.
 

Bella Cullen

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If my doctor did a mini open rotator cuff repair, subacromial decompression, arthroscopic Mumford, and debridement of a labral tear in the glenohumeral joint, may I bill out
23412, 29824-51, 29826-59, 29822-59? The order is based on Blue Cross allowables.
Per the dictation, 23412 and 29826 are separate incisions and 29822 is in a different compartment than 29826 and 29824. Or due to the new guidelines, are we to bill only 23412, 29824-51, and 29822-59? I still can't get it straight in my head why we can't bill 23412 and 29826-59. Is there a rule that we can't modify an add-on code w/ -59? Thank you to anyone who can help me understand.
29826 is now an add on code and can only be billable in conjunction w/ 29806-29825, 29827-29828.
So since doc also did 29824 and 29822 then u can bill it also because one of those codes are being billed also.
If it was ONLY 23412 then you cannot bill 29826 because that is not one of the codes u can bill w/ that add on code per CPT book.
I went to a seminar yesterday and they said in that situation, you can bill 29822 or 29823 instead of 29826 when done w/ 23412.

Workshop was done by mary legrand, from the CT Orthopaedic Society, on Mastering Ortho coding.
 

risnerclan

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here is the problem we are having.

we do the 29826 as an add on code along with one of the other codes but they also do a open RCR 23412 and it shows the 29826 included with 23412??? NOW WHAT?
 

Bella Cullen

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here is the problem we are having.

we do the 29826 as an add on code along with one of the other codes but they also do a open RCR 23412 and it shows the 29826 included with 23412??? NOW WHAT?
As long as you bill w/ one of the other codes it should be fine.
Per AAOS CCI edits, u need a 59 mod on 29826 when billed with 23412. But DO NOT bill 29826 alone w/ 23412. It needs one of those other codes i listed in my previous response.
 

choppe

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I have a similar situation, but it includes a biceps tenodesis. Is it appropriate to bill all of these codes together?

PROCEDURES:
Right shoulder arthroscopy 29826-59
Labral debridement (included in 29826)
Mumford procedure 29824-51
Open rotator cuff repair 23412 (identified as a chronic tear)
Acromioplasty (included in 23412) this was done first arthroscopically and then during the open procedure with a bursectomy
Biceps tenodesis 23430 (or 24341) with -51
 

Bella Cullen

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I have a similar situation, but it includes a biceps tenodesis. Is it appropriate to bill all of these codes together?

PROCEDURES:
Right shoulder arthroscopy 29826-59
Labral debridement (included in 29826)
Mumford procedure 29824-51
Open rotator cuff repair 23412 (identified as a chronic tear)
Acromioplasty (included in 23412) this was done first arthroscopically and then during the open procedure with a bursectomy
Biceps tenodesis 23430 (or 24341) with -51
Yes because you have 29824 to support billing the 29826. If you didnt have 29824 then you would only be able to bill 29822 or 29823 along with 23412 and 23430.
 

kc-george

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Sorry to jump on, but I just wanted to clarify, so we cannot bill 23412 and 29826 as an add on??!! :( I was not aware of that.
 
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