Question CPT 29826

karinquiterio

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Good morning coders! We are starting to get denials on CPT 29826 as "inclusive" to other procedures. Anyone trying to fight these and if so how?

Thanks in advance! Have a great day!:D
 

Orthocoderpgu

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Need a little more information than that in order to help. What procedures is it being bundled into? 29827, 29828, 29824, 29823? Has the insurance looked at the op note? Are the requirements for billing 29826 being met and backed up by pathology and not just being done as part of a shoulder scope?
 

karinquiterio

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It is pretty much something my docs do at every scope due to impingement but in almost all cases now they are saying it is "payable with another service". No we do not send the operative reports with the billing as it is electronic but I think we may have to.
 

Orthocoderpgu

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It is pretty much something my docs do at every scope due to impingement but in almost all cases now they are saying it is "payable with another service". No we do not send the operative reports with the billing as it is electronic but I think we may have to.
I've been coding orthopedic surgeries for eight years and understand that this is a frequently performed procedure for impingement. I'm sure your billing it with another shoulder procedure in the same section which is required. Insurance companies also understand that this procedure is not always documented correctly. The physician must document both parts the subacromial decompression & the acromioplasty. If both are not documented, the code is not supported. If it's properly paired I don't understand how the insurance can deny it.
 

richelle25

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I spoke w/ AIM Specialty and was told that 29826, subacromial decompression/acromioplasty is considered not medically necessary for all indications. I was told as of 09/26/2020 this would also be Medicare's guideline regarding 29826. Does anyone have any information regarding this? Thanks
 

Orthocoderpgu

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I spoke w/ AIM Specialty and was told that 29826, subacromial decompression/acromioplasty is considered not medically necessary for all indications. I was told as of 09/26/2020 this would also be Medicare's guideline regarding 29826. Does anyone have any information regarding this? Thanks
I don't see how they can say that. If impingement is documented, and it almost always is, then it would be medically necessary. Considering that 29826 is an "debridement" procedure, I would look for other debridement that you could pair up with it and possibly bill 29823 instead. Not all payers are considering 29823 for benefits, but it's worth billing when you can.
 
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