Rcr w/ total shoulder

nyyankees

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I need a little input here. when a dr peforms a total shoulder and rotator cuff repair (RCR) do you bill out both AND get paid? I always follow the NCCI edits and ONLY bill out with a 59 mod if the dr CLEARLY documents a separate issue.

Am I wrong? Can you always bill out a RCR with a Total Shoulder and just add 59 mod to bypass edit?

I a little confused on this. Thanks....:confused:
 

mbort

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my personal opinion....it bundles per NCCI....I've never seen documentation that would/could warrant the justification of bypassing the edits with a 59 modifier.

Mary, CPC, COSC
 

nyyankees

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I agree with that...but now I'm being told that AAOC states we can bill out the RCR with a Total Shoulder and I'm now instructed to do so. I didn't find any articles (still looking) on the AAOS website. That's why I figured I'd ask around.

Thanks..:(
 

mbort

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I agree with that...but now I'm being told that AAOC states we can bill out the RCR with a Total Shoulder and I'm now instructed to do so. I didn't find any articles (still looking) on the AAOS website. That's why I figured I'd ask around.

Thanks..:(
If you find something please post..I'd love to be able to capture it :)
 
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