Assuming this is Medicare/government. WC or commercial might have different edits. Only read op note quickly assuming these are properly documented according to code descriptions, assuming correct laterality mod will be added.
Check these in the GSD, NCCI, and CPT Guidelines:
27487 - 22
27640
20245 (no edit with 27487 but edit w/ 27640 where 27640 is Column 1- standards of med/surg)
76000 -26 (no edit with 27487 but has "separate procedure" designation might or might not be paid; read the definition of separate procedure in CPT)
97605
When you have a big case like this where the provider wants all the codes and 59s and you are not sure:
Start with the 27487-22. Check each individual, additional code w/ that 1st. Then decide which CPT you are left with. Then, run those all together and see how that comes back. You can't start out running all of them together because a # are integral to the 27487 and actually hitting edits against one another too and not just the 27487.
Run all those codes through NCCI edits, read the NCCI manual, look at your CPT guidelines, and GSD.
You have a P2P edits going on here where 59 is not appropriate.
Some examples: Misuse of Column Two code with Column One (27487) code: 11044, 20704
More extensive procedure (27487): 27303, 27350
You want to read what these NCCI terms mean, like "standards of medical surgical practice", "more extensive procedure", and "misuse of column 1 with column 2":
https://www.cms.gov/files/document/01-chapter1-ncci-medicare-policy-manual-2026-final.pdf
https://ams.aaos.org/Online-Store/Product-Detail?id={FEA0469B-A5FB-F011-8406-6045BD065094}&_ga=2.149671092.384152397.1781267486-423841591.1780999966
