salindarose
Guest
I have a surgeon that is pushing the issue of billing CPT 29823, arthroscopic debridement, extensive with nearly every arthroscopic procedure of the shoulder he performs. I have shown him the NCCI manual section that addresses this,
CMS NCCI manual states, “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.”
But he is stating that his "other office bills it all the time". I guess if the payer does not follow CMS guidelines, then I can maybe bill it for some of his procedures, BUT then when reading his OP Report he dictates statements regarding doing the debridement for visualization rather than for a therapeutic benefit -- "An extensive debridement of the shoulder anteriorly, laterally, medially and posteriorly was used using appropriate portals as needed for instrumentation.".
Am I on the right track or am I the one that is off base in telling him we can't bill the debridement separately in most procedures.
Thanks in advance!
CMS NCCI manual states, “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.”
But he is stating that his "other office bills it all the time". I guess if the payer does not follow CMS guidelines, then I can maybe bill it for some of his procedures, BUT then when reading his OP Report he dictates statements regarding doing the debridement for visualization rather than for a therapeutic benefit -- "An extensive debridement of the shoulder anteriorly, laterally, medially and posteriorly was used using appropriate portals as needed for instrumentation.".
Am I on the right track or am I the one that is off base in telling him we can't bill the debridement separately in most procedures.
Thanks in advance!
