29826 or unlisted w/unrelated procededure

terribo

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I have a situation where code 29826 for the subacromial decompression was done on the left shoulder as well as code 25111 for excision of a ganglion cyst of the wrist-totally unrelated procedures.

In the decription of code 29826, I realize that code 29826 has to be billed as 29826 with codes 29806-29825, & 29827-29828 and that if code 29826 is done in conjunction with codes 23130 or 23415, that we cannot bill code 29826 separately, the procedures must be billed only as 23130 or 23415. I also realize that if code 29826 is done by itself, without any other procedures performed, that we use code 29999. I get all that.

What I am kind of torn about is code 29826 for SAD of shoulder being billed with code 25111 for the wrist.

I am thinking that since technically 29826 is not being billed w/any other arthroscopic procedure as mentioned above and that the open procedure 25111 performed is unrelated to the shoulder, that the arthroscopic procedure 29826 should be billed unlisted as 29999 and that code 25111 should be billed as the primary procedure. Modifier 51 on code 29999?

Any thoughts? :eek:
 

nyyankees

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I have a situation where code 29826 for the subacromial decompression was done on the left shoulder as well as code 25111 for excision of a ganglion cyst of the wrist-totally unrelated procedures.

In the decription of code 29826, I realize that code 29826 has to be billed as 29826 with codes 29806-29825, & 29827-29828 and that if code 29826 is done in conjunction with codes 23130 or 23415, that we cannot bill code 29826 separately, the procedures must be billed only as 23130 or 23415. I also realize that if code 29826 is done by itself, without any other procedures performed, that we use code 29999. I get all that.

What I am kind of torn about is code 29826 for SAD of shoulder being billed with code 25111 for the wrist.

I am thinking that since technically 29826 is not being billed w/any other arthroscopic procedure as mentioned above and that the open procedure 25111 performed is unrelated to the shoulder, that the arthroscopic procedure 29826 should be billed unlisted as 29999 and that code 25111 should be billed as the primary procedure. Modifier 51 on code 29999?

Any thoughts? :eek:
The only way you could capture something from the 29826 is if there is documentation of s Debridement 29822-29823. That's all. No 29826 or Unlisted 29999 allowed..
 

kc-george

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So, (not to detract from the question), but if all the doctor performed is a SAD, what then? Is there a way to bill out for this, if the patient had negative pathology, and NOTHING else done other that the SAD arthroscopically?
 

terribo

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KC George...I am under the understanding that if the SAD is all that was performed, then it would need to be submitted as Unlisted code 29999 and compare the price of that of code 29826.

NY Yankees...so now I am really confused from your response. Here is the documentation from the OP report for the SAD:

The arthroscope was removed and placed in the subacromial
space. A midlateral portal was created with spinal needle localization.
Subacromial bursectomy was performed with a combination of motorized shaver
and VAPR tissue ablator. The coracoacromial ligament was released from the
inferior aspect of the anterior acromion. An anterior inferior acromial
spur as well as inferior clavicular osteophytes were noted. The patient
had a subacromial decompression performed with a 5.5 barrel bur using
posterior reference cutting block technique. The infraclavicular
osteophytes were coplaned to the acromion with the 5.5 bur. The
subacromial space was thoroughly irrigated and debrided with a shaver. The
arthroscopic equipment was removed. The portals were closed with 3-0
Nylon.


The Op note then goes on to describe the ganglion excision from the wrist procedure.

If I read your response correctly...I can't bill the SAD even though it is in the shoulder and the other procedure was in the wrist? Should we be billing a 29822 based on the documentation above? :confused:
 

nyyankees

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So, (not to detract from the question), but if all the doctor performed is a SAD, what then? Is there a way to bill out for this, if the patient had negative pathology, and NOTHING else done other that the SAD arthroscopically?
If only SAD is performed you would report Unlisted 29999 and compare to 29826 RVU of 2011 as 2012 RVU is for an add-on code and much lower..
 

nyyankees

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KC George...I am under the understanding that if the SAD is all that was performed, then it would need to be submitted as Unlisted code 29999 and compare the price of that of code 29826.

NY Yankees...so now I am really confused from your response. Here is the documentation from the OP report for the SAD:

The arthroscope was removed and placed in the subacromial
space. A midlateral portal was created with spinal needle localization.
Subacromial bursectomy was performed with a combination of motorized shaver
and VAPR tissue ablator. The coracoacromial ligament was released from the
inferior aspect of the anterior acromion. An anterior inferior acromial
spur as well as inferior clavicular osteophytes were noted. The patient
had a subacromial decompression performed with a 5.5 barrel bur using
posterior reference cutting block technique. The infraclavicular
osteophytes were coplaned to the acromion with the 5.5 bur. The
subacromial space was thoroughly irrigated and debrided with a shaver. The
arthroscopic equipment was removed. The portals were closed with 3-0
Nylon.


The Op note then goes on to describe the ganglion excision from the wrist procedure.

If I read your response correctly...I can't bill the SAD even though it is in the shoulder and the other procedure was in the wrist? Should we be billing a 29822 based on the documentation above? :confused:
You can't capture 29826 with an open procedure (i.e. 23412). But you could capture a Debridement (29822, 29823). In your case I would capture 29822 for the bursectomy. Hope this helps..
 

nyyankees

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KC George...I am under the understanding that if the SAD is all that was performed, then it would need to be submitted as Unlisted code 29999 and compare the price of that of code 29826.

NY Yankees...so now I am really confused from your response. Here is the documentation from the OP report for the SAD:

The arthroscope was removed and placed in the subacromial
space. A midlateral portal was created with spinal needle localization.
Subacromial bursectomy was performed with a combination of motorized shaver
and VAPR tissue ablator. The coracoacromial ligament was released from the
inferior aspect of the anterior acromion. An anterior inferior acromial
spur as well as inferior clavicular osteophytes were noted. The patient
had a subacromial decompression performed with a 5.5 barrel bur using
posterior reference cutting block technique. The infraclavicular
osteophytes were coplaned to the acromion with the 5.5 bur. The
subacromial space was thoroughly irrigated and debrided with a shaver. The
arthroscopic equipment was removed. The portals were closed with 3-0
Nylon.


The Op note then goes on to describe the ganglion excision from the wrist procedure.

If I read your response correctly...I can't bill the SAD even though it is in the shoulder and the other procedure was in the wrist? Should we be billing a 29822 based on the documentation above? :confused:
29826 can only be reported with 29806-29825, 29827, 29828..
 
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