Wiki Can you bill 29827 & 23412 for the same shoulder?

Orthocoderpgu

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I'm getting conflicting information. 29827 & 23412 have an NCCI edit of 1, meaning that a modifier is allowed. Does that mean that if they are performed on different tendons that both are allowed on the same shoulder? I'm getting conflicting information and some of it may be due to older information. Any feedback would be appreciated.
 
Was the arthroscopy a scout procedure? If so its not separately reported.

If arthroscopic converted to open procedure, only the open should be reported

I believe the 1 is only if done on a separate joint
 
One tendon is being repaired arthroscopically and another tendon is being repaired via a mini-open procedure. I am being told that since the repairs are on different tendons that both 29827 & 23412 can both be billed. All of this is on the same shoulder.
 
Per NCCI policy manual for Medicare Services - CMS considers the shoulder to be a single anatomic structure. An NCCI procedure to procedure edit code pair consisting of two codes describing two shoulder procedures should never be bypassed with an NCCI-associated modifier when performed on the ipsilateral shoulder. This type of edit may be bypassed only if the two procedures are performed on contralateral shoulders.

It's important to note that both code descriptors state repair of rotator cuff. It does not say one tendon of the rotator cuff. The rotator cuff is a group of four muscles or tendons. Each procedure code encompasses the repair of all of these.
 
One tendon is being repaired arthroscopically and another tendon is being repaired via a mini-open procedure. I am being told that since the repairs are on different tendons that both 29827 & 23412 can both be billed. All of this is on the same shoulder.


I have a question regarding this subject, as I have a similar issue. My doctor did a superior rotator cuff repair and did debridement of shoulder adhesions through the scope, but then due to a difficulty with the repair of the subscap, he decidied to do an open repair the subscap. I understand what was said about the edits, where if they are bundled and on the same shoulder that it would be inappropriate to add a 59, I just want to make sure that I am reporting this procedure properly and not cutting my doctor short on anything. So due to the eidts here, does this mean I should only report 23412 or should I only report the 29827?
 
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Coding guidelines state that if a procedure is started arthroscopically and converted to an open procedure, that only the open procedure is reported. Since the RTC tendons are considered one anatomic location, especially by CMS, only one repair can be reported. Unfortunately the open procedures have less RVU value than arthroscopic procedures.
 
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