coding for manipulation

cfrantz

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I have a question about coding a shoulder manipulation (23700) with 29826, and 29823----the ENCODER PRO program I have states that this is allowed with a modifier and documentation------and I know that most of the time, it is payable at the discretion of the payer----- Another coder aquaintance of mine did bill this together, and was told that the manipulation could only be billed for the other shoulder---not the one treated----infact, her audit marked this code against her-----so how do you bill if the edits state "allowed with modifier and documentation"------Are there two different set of edits for these codes?----This is very confusing:confused:
 

kevbshields

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I believe there's some confusion over the use of this code. It is standard for manipulation to go on before a surgery. Sometimes this occurs so the treating physician can have a better idea of possible surgical interventions. However, there are occasions that it becomes medically necessary to perform the manipulation after the surgery is complete, or to address a specific problem that cannot be repaired arthroscopically or via an open approach.

This 23700 code is to be coded with Modifier -59 when it is medically necessary (based on a particular purpose, other than diagnostic that relates in surgical intervention) to be performed separately and distinctly from the arthroscopic surgery (or other services).

Unless I have missed something from Federal sources, the instance(s) mentioned above would be the only appropriate time to append Modifier -59, expect and bill for reimbursement. Otherwise, this is unbundling.

Good luck.
 

cfrantz

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This particular op note just states--"Under anesthesia, the patient's range of motion was limited to approximately 90 degrees of elevation, 45 degrees of external rotation, and 30 degrees of internal rotation. With gentle manipulation, full range of motion was obtained in all planes."'----

Then the arthroscopic part of the surgery started------so this would be bundled, yes----
 
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