CPT code 29823

along06

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Help!!!! Does anybody know the latest on CPT code 29823? Is it consider inclusive with 29824 and 29827 now?

Thanks
Abbie
 

Orthocoderpgu

True Blue
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The answer is Yes and No

Per the 2017 CMS NCCI Surgical Policy Manual code 29823 CAN be billed with 29824, 29827 & 29828 ONLY. Remember this is a CMS policy.

For CMS or those who follow CMS guidelines, yes you can bill 29823.

Private insurance may or may not follow this guideline.

29822 is only billable if it is the only code being billed.
 

Set_Apart

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I agree with orthocoderpgu.

I'd also just like to add the actual CMS guideline for your review:

"Shoulder arthroscopy procedures include limited debridement (e.g., CPT code 29822) even if the limited debridement is performed in a different area of the same shoulder than the other procedure. With three exceptions, shoulder arthroscopy procedures include extensive debridement (e.g., CPT code 29823) even if the extensive debridement is performed in a different area of the same shoulder than the other procedure. CPT codes 29824 (arthroscopic claviculectomy including distal articular surface), 29827 (arthroscopic rotator cuff repair), and 29828 (biceps tenodesis) may be reported separately with CPT code 29823 if the extensive debridement is performed in a different area of the same shoulder."
 

JillSmithers

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I have denials for this from BCBS NC and Aetna. Is that the experience of others? Anyone know an official policy from these 2 insurances?
 

Orthocoderpgu

True Blue
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I see BX deny 29823 as well

The previous information about code 29823 is correct, however BXBS is one of the last insurance companies to understand this code. BX thinks that any debridement is part of a restorative procedure which is just not the case. Don't expect BX to pay for 29823. The good thing is that CMS is paying for this code and most insurance companies will eventually follow what they do, but expect BX to be the last insurance company to get this correct.
 

KMCFADYEN

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29823 bundling

I am aware of the Anthem and Aetna bundling as they use McKesson edits and not NCCI
my problem as of today is that I now have a CMS denial for 29823 as a bundled code with 29826
anyone else?
 

Orthocoderpgu

True Blue
Local Chapter Officer
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Rare to bill 29823 & 29826 together

I'm assuming the doc performed a rotator cuff repair and possibly a biceps tenodesis.

Code 29823 is for extensive debridement.

Rare to bill 29826 with it, since there is not much other tissue left to debride that a restorative procedure was not performed on which is probably why you are getting the denial.
 
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CPT Code 29823 and BC/BS

Our practice was having the same problem with BC/BS denying CPT Code 29823. The Blues were in the middle of installing updates to their system between Fall 2018 and Spring 2019. Luckily, they have recognized the issue and have now started reimbursing CPT Code 29823 when it is accompanied with 29827, 29824, 29828, etc. BC/BS should be doing a massive reprocessing of these previously denied claims, but a phone call couldn't hurt push your claims along.
 
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