Wiki Anterior & Posterior capsulorrhaphy

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iowagirl77

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I read an interesting AAOS article ( https://www.aaos.org/AAOSNow/2018/M...Roundup - March 2018&utm_medium=email&ssopc=1 ) recently, and wondered about this:

Code 29806 covers both anterior and posterior capsulorrhaphy. If a repair is done both anteriorly and posteriorly, it would be coded as 29806-22. The modifier 22 signifies more work than usual.

I've never heard that we could use a 22 mod for this- I had assumed payment for 29806 covered anterior and/or posterior repairs. I haven't seen this advice elsewhere. Has anyone been coding it this way? What are your thoughts on this?
 
I have used 29806-22

Many times going from the anterior to the posterior is not that difficult and is done through the same portals. In those cases I just bill out 29806. However, if the physician has to go into the anterior, and then access the posterior through a separate approach, then I have used the -22 modifier due to the extra effort. Many times there are other factors as well.

I would not use -22 automatically. There needs to be extra work performed and why documented or the insurance is not going to allow it.
 
Thanks! I wanted to make sure I wasn't losing out on revenue for my providers, but I agree it generally doesn't seem warranted to add the 22. My providers like to take AAOS's word over CMS on many things, so I wanted to check on this.
 
Docs always go with AAOS over CMS

If I had it my way all ortho claims would follow AAOS too. But we are at the mercy of the insurance companies.

Keep track of claims as you bill them. You will find that many follow CMS, and others follow AAOS.

Before coding any surgery you really have to know which insurance company is processing the claim, that will let you know which set of guidelines to use as you code and submit.
 
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