CPT 29826 denials

[kkindle1807]

I'm inquiring to see if anyone else is having an issue with CPT 29826 not getting paid even though the operative report is stating both subacromial decompression and acromioplasty in a separate paragraph.
We are noticing an increase in denials when 29826 is billed along with 29827, 29828, 29823 (the extensive debridement will be outlined in a separate paragraph from the subacromial decompression and acromioplasty).
It's not just these 4 procedures billed out that are denying the 29826, it can be any combination, 29827, 29823, 29824, 29826 - they are still denying the 29826.

Forgot to add, we always include a 59 modifier on the 29826.

Has anyone else noticed this and if so have you come up with any solutions that don't require a write off?

 

[NRaizman]

The reason 29826 is being denied is for lack of medical necessity. It has nothing to do with the coding.

Subacromial decompression has not been shown, either alone or when it is done in conjunction with cuff repair, to have any benefit. This is part of the AAOS Clinical Practice Guidelines for Rotator Cuff. Makes it hard to justify.

It will still generally get paid by CMS, but third party payors are mostly denying it across the board. It is unlikely to be worth appealing, and I would recommend only using the bursa and acromion as structures for debridement to count towards 29823.
N