orthobiller2017
Networker
Hi- for years despite the NCCI edit being removed we have received denials for CPT code 29823 when billed with 29827, 29824, or 29828. I understand most payors use McKesson software which finds debridement integral. Question is the wording from McKesson can possibly be intrepreted as modifier 59 permitted if the debridement is in different areas than the other work.
Which for our surgeons is the case as they are debriding the labrum, synovitis, cartilage, biceps, etc.
Now I am old school and I don;t believe in adding 59 unless it was the other shoulder. However, if this is specific payor policy then perhaps 59 would be appropriate in this instance?
Appeals with substantiation deny as if the only solution would be to add 59
Has anyone else encountered this and decided to append 59?
Thank you
"Certain procedures are commonly performed in conjunction with other procedures as a component of the overall service provided. An incidental procedure is one that is performed at the same time as a more complex primary procedure and is clinically integral to the successful outcome of the primary procedure.Modifier -59 may be used to identify the performance of a distinct procedural service, unrelated to the primary procedure"
Which for our surgeons is the case as they are debriding the labrum, synovitis, cartilage, biceps, etc.
Now I am old school and I don;t believe in adding 59 unless it was the other shoulder. However, if this is specific payor policy then perhaps 59 would be appropriate in this instance?
Appeals with substantiation deny as if the only solution would be to add 59
Has anyone else encountered this and decided to append 59?
Thank you
"Certain procedures are commonly performed in conjunction with other procedures as a component of the overall service provided. An incidental procedure is one that is performed at the same time as a more complex primary procedure and is clinically integral to the successful outcome of the primary procedure.Modifier -59 may be used to identify the performance of a distinct procedural service, unrelated to the primary procedure"