Billing code 29826

blasterfish

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My local Medicare carrier is denying codes 29822 & 29826 stating code 29822 requires a 59 modifier??!! I understood that with code 29826 being an add-on code it didn't require modifier usage?! HELP!!!!
 

RebeccaWoodward*

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My local Medicare carrier is denying codes 29822 & 29826 stating code 29822 requires a 59 modifier??!! I understood that with code 29826 being an add-on code it didn't require modifier usage?! HELP!!!!
There has been some confusion on how to use this code. The AMA has corrected it's language in CPT's errata. You may want to send a copy of this to your MAC with an appeal letter.



Surgery
Musculoskeletal System
Endoscopy/Arthroscopy


29806 Arthroscopy, shoulder, surgical; capsulorrhaphy

+▲29826 decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (List separately in addition to code for primary procedure)

(For open procedure, use 23130 or 23415)

►(Use 29826 in conjunction with 29806-29825, 29827, 29828)◄
29827 with rotator cuff repair

(For open or mini-open rotator cuff repair, use 23412)

(When arthroscopic subacromial decompression is performed at the same setting, use 29826 and append 51)

(When arthroscopic distal clavicle resection is performed at the same setting, use 29824 and append modifier 51)

Remove the parenthetical note following 29827 referencing when arthroscopic distal…use 29826 and append 51, as code 29826 has been revised to an add-on code and therefore, no longer appropriate to append modifier 51.


http://www.ama-assn.org/resources/doc/cpt/cpt-corrections.pdf
 

cbeuerlein

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This is part of an article from Orthopedic Decision (Orthopedic Coder's Pink Sheets)

CCI plains to delete the edits with the April 1 code pair update (Version 18.1), according to correspondence obtained by OCPS. However, the changes will be retroactive to Jan. 1, 2012.

“After April 1, 2012, the provider may resubmit the claim if the local A/B MAC permits, or appeal previously denied claims involving the NCCI code pair edit,” a CCI official states. “As an alternative, providers may also choose to hold claims” until after the edits are deleted.

http://ortho.decisionhealth.com/Articles/Detail.aspx?id=511576
 

cpccpma

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29822 is not one of the parent codes of 29826 so you will bill only 29822 or 29823 if bony debridement is done. The AMA issued a statement saying it is not appropriate to bill 29826 as unlisted-which is what we were told to do from the start-and it should be reported as 29822 or 29823. Now if you are performing one of the parent codes then bill 29826 and you should be paid 100% of allowable since it is now an add on code and the rvu's are so very low. Hope this helps. :)
 

cbeuerlein

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AAOS and AMA list 29822 as a parent code to 29826. NCCI denies when billed together but a correction will be made April 1, 2012 per Orthopedic Decision that is retroactive to Jan. 1, 2012.

29826 "arthroscopic subacromial decompression”—is now an add-on code to CPT codes 29806–29825, 29827, and 29828.

CPT Professional edition 2012 states under 29826 “use 29826 in conjunction with 29806-29825,29827, 29828.”

http://www.aaos.org/news/aaosnow/jan12/managing4.asp

http://www.beckersasc.com/asc-codin...pression-revision-brings-about-questions.html
 

lizzardb

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29822 is not one of the parent codes of 29826 so you will bill only 29822 or 29823 if bony debridement is done. The AMA issued a statement saying it is not appropriate to bill 29826 as unlisted-which is what we were told to do from the start-and it should be reported as 29822 or 29823. Now if you are performing one of the parent codes then bill 29826 and you should be paid 100% of allowable since it is now an add on code and the rvu's are so very low. Hope this helps. :)
Do you have a link to where they issued that statement about not billing 29826 as unlisted? I'm trying to show my physician that it will not get us into trouble to bill it that way, when the subacromial decompression is done by itself. (or am I misunderstanding what you are saying?)
 

cpccpma

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This is directly from the AMA who checked w/AAOS:

Just heard back from the AMA and they checked with AAOS and they state if that if the only thing you are doing is acromioplasty then you would NOT report the unlisted but you would report 29822 or 29823.

"...if the only arthroscopic decompression of subacromial space with partial acromioplasty performed, code 29822, Arthroscopy, shoulder, surgical; debridement, limited, or code 29823, Arthroscopy, shoulder, surgical; debridement, extensive, would be reported as appropriate. The fact that the term "decompression" is not mentioned in the code descriptor does not affect the reporting. It would NOT be appropriate to report an unlisted code when an arthroscopic subacromial decompression is the only procedure performed..." Opinion from the AMA
 
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