Wiki Arthroscopic Shoulder Surgery-Modifiers 51 and 59

[Desperate Denise]

Hi all - I am new to AAPC and am looking for help with coding shoulder surgeries using modifiers 51 and 59.

The physician performed a subacromial decompression for impignement and a debridement of a labral tear including a superior labral and anteroposterior tear and a primary repair of a rotator cuff including the supraspinatus portion.

I coded it as 29827, 29826-59 and 29822-59. Someone from AAOS told me the modifier for 29826 should be 51 and the 29822 is included. Please help.

My next issue is an arthroscopic repair of a rotator cuff, subacromial decompression, distal clavicle excision, debridement of labrum and debridement of biceps tendon.

I coded it as 29827, 29826-59, 29824-59, 29823-59

I was then told to change it to 29827, 29826-51, 29824-51 and to leave off the 29823. Please help me!!!

Thank you so much - desperate d

 

[Bella Cullen]

Hi all - I am new to AAPC and am looking for help with coding shoulder surgeries using modifiers 51 and 59.

The physician performed a subacromial decompression for impignement and a debridement of a labral tear including a superior labral and anteroposterior tear and a primary repair of a rotator cuff including the supraspinatus portion.

I coded it as 29827, 29826-59 and 29822-59. Someone from AAOS told me the modifier for 29826 should be 51 and the 29822 is included. Please help.

My next issue is an arthroscopic repair of a rotator cuff, subacromial decompression, distal clavicle excision, debridement of labrum and debridement of biceps tendon.

I coded it as 29827, 29826-59, 29824-59, 29823-59

I was then told to change it to 29827, 29826-51, 29824-51 and to leave off the 29823. Please help me!!!

Thank you so much - desperate d

The first one I would bill as 29827, 29826-51, 29822-5951.
The second one I would bill as 29827, 29826-51, 29823-5951, 29824-51.

59 modifier is for a Separate Procedure, to show that it should not be bundled with the prime procedure, and 51 is just for multiple procedures.

I used medicare's edits for this one.
Hope this helps,
Melissa, CPC

 

[Desperate Denise]

Desperate Denise

Melissa - thank you so much - I really appreciate it - Blue Shield is checking into our use of modifiers 51 and 59. There will probably be more questions. I am just a little anxious so apologize for so many questions.

Have a great weekend - thanks again!!!