Wiki New NCCI shoulder Arthroscopic bundeling

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Hi

Does anyone have documentation that you can no longer bill


29827 with 29822 59

Due to the 01/2013 NCCI update page 4 number 22

Any official documentaion
 
Here is an email I received:


There has been a WHOLE lot of misunderstanding regarding shoulder arthroscopy procedures and what you can and cannot bill.
To help clarify this here are some examples:

Surgeon does 29827, 29828, 29824, 29822 and 29826 - per CCI you should only report 29827, 29828, 29824 and 29826 as 29822 is bundled into 29827 and 29824 and CCI states you should not append modifier 59 unless it is the other shoulder.

Surgeon does 29824, 29822 and 29826 - per CCI you should only report 29824 nd 29826 for the same reason of 29822 being bundled.

Surgeon performs 29822 and 29826 - per CCI you should report both as there are no bundling issues.

The guidelines are NOT saying you can only report one shoulder code for ALL cases, they are saying if there are bundling issues modifier 59 would not be appropriate unless it is the other shoulder. If there are NO bundling issues there is no modifier 59 issue and you can bill the codes.

Again this applies to payers/carriers who follow and use the NCCI guidelines - In chapter one the full paragraph states:
"Use of modifier 59 to indicate different procedures/surgeries does not require a different diagnosis for each HCPCS/CPT coded procedure/surgery. Additionally, different diagnoses are not adequate criteria for use of modifier 59. The HCPCS/CPT codes remain bundled unless the procedures/surgeries are performed at different anatomic sites or separate patient encounters.
From an NCCI perspective, the definition of different anatomic sites includes different organs or different lesions in the same organ. However, it does not include treatment of contiguous structures of the same organ. For example, treatment of the nail, nail bed, and adjacent soft tissue constitutes treatment of a single anatomic site. Treatment of posterior segment structures in the ipsilateral eye constitutes treatment of a single anatomic site. Arthroscopic treatment of a shoulder injury in adjoining areas of the ipsilateral shoulder constitutes treatment of a single anatomic site."

Again if there are no NCCI bundling issues between the codes you are wanting to report there is no issue and you should be able to bill. The main codes in question appear to be 29820-29823.

Now as of Jan 2013 in Chapter 4 they continued this issue regarding modifier 59 for ALL shoulder joint procedures not just arthroscopy. So again some examples:

Surgeon does 23472 (total shoulder) and 23430 (biceps tenodesis) - per AAOS they state you can bill, but per NCCI they are bundled and now they are saying modifier 59 should not be appended. So again issues of who follows NCCI edits and guidelines. Per NCCI you should just report 23472

Surgeon does 23120 and 23130 - Acromioplasty and Mumford open - per NCCI there are no bundling issues so both codes can be reported.

Again the same issue applies - you can code the procedures being performed per NCCI as long as there is not a bundling issue as they are now saying that modifier 59 should not be used unless other shoulder. It only again applies if there are edits you are trying to bypass.
Chapter 4 guideline states:
"22. CMS considers the shoulder joint to be a single anatomic structure. An NCCI procedure to procedure edit code pair consisting of two codes describing two shoulder joint procedures should never be bypassed with an NCCI-associated modifier when performed on the ipsilateral shoulder joint. This type of edit may be bypassed only if the two procedures are performed on contralateral joints."

Hopefully that helps

Margie Scalley Vaught, CPC, CPC-H, CPC-I, CCS-P, MCS-P, ACS-EM, ACS-OR
Auditing, Coding, Documentation and Compliance Consulting
Healthcare Consultant
scalley123@aol.com
cell 360-880-8304
fax 413-674-7668
www.margievaught.com
for workshops and audio http://www.margievaught.com/calendar/index.cfm
 
Slap/ 29822?

So then does this mean a 29822 for a Type I SLAP debridement is bundled when a
23412 & 29824 & 29826 is also done? Bundled with the 29824?

Brenda M
 
Another Quesion on Shoulder Surgery

Surgical Procedures:

Closed Manipulation of shoulder
Arthroscopy of shoulder
Subacromial Decompression
Resection distal clavicle
Chondroplasty
Biceps Tenotomy [high grade tear of biceps, superior labrum]
Arthroscopy Repair of rotator cuff tear

I coded as follows:
CPT 29827
CPT 29826
CPT 29824

Question: Can I code for the Biceps Tenotomy with labral excision and Debridement
with 29823??

Thanks
 
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