Wiki shoulder surgery coding

[sbowery]

Hi everyone - I am not versed in coding shoulder surgeries so I am having a very difficult time. Would someone be willing to look at the attached op report. The surgery coder used the following codes:
29827 LT
23430 51, LT
29823 59, LT
23120 51, LT

An outside source(not the insurance) has indicated to our office that this was inappropriate unbundling. I would appreciate any input. Thanks

 

[OpenClaims]

I am reading into this, I will get back with you once complete. Wanted to let you know that your question won't go unanswered!

 

[amyjph]

29823 is not correct, there were not three or more discrete structures debrided. You can't count the debridement/preparation done on the rotator cuff or biceps tendon as it is part of 29827 & 23430 or the bursectomy/synovectomy as it's part of the acromioplasty. That leaves just the labral debridement and that would be 29822 which bundles. Appending a 59 modifier is not correct in this case and is inappropriate undbundling.

If you or your office doesn't have it I suggest you obtain copies of the AAOS Complete Global Service Data for Orthopedic Surgery books. Also, read the NCCI manual musculoskeletal section.

The AAOS book shows 29826 is separately reportable with 23120, you would want to check payer guidelines and possibly CPT assistant or other reputable sources to see if that could be reported for the acromioplasty. It does have a p2p edit w/ 23120 though.

 

[sbowery]

29823 is not correct, there were not three or more discrete structures debrided. You can't count the debridement/preparation done on the rotator cuff or biceps tendon as it is part of 29827 & 23430 or the bursectomy/synovectomy as it's part of the acromioplasty. That leaves just the labral debridement and that would be 29822 which bundles. Appending a 59 modifier is not correct in this case and is inappropriate undbundling.

If you or your office doesn't have it I suggest you obtain copies of the AAOS Complete Global Service Data for Orthopedic Surgery books. Also, read the NCCI manual musculoskeletal section.

The AAOS book shows 29826 is separately reportable with 23120, you would want to check payer guidelines and possibly CPT assistant or other reputable sources to see if that could be reported for the acromioplasty. It does have a p2p edit w/ 23120 though.

Thank you so much for the detailed information, it helps with clarification. We do have the AAOS books but was not aware that CMS doesn't always agree with what is inclusive and what is not. This information will help me and the coder. I appreciate you taking the time to help me.

 

[OpenClaims]

29823 is not correct, there were not three or more discrete structures debrided. You can't count the debridement/preparation done on the rotator cuff or biceps tendon as it is part of 29827 & 23430 or the bursectomy/synovectomy as it's part of the acromioplasty. That leaves just the labral debridement and that would be 29822 which bundles. Appending a 59 modifier is not correct in this case and is inappropriate undbundling.

If you or your office doesn't have it I suggest you obtain copies of the AAOS Complete Global Service Data for Orthopedic Surgery books. Also, read the NCCI manual musculoskeletal section.

The AAOS book shows 29826 is separately reportable with 23120, you would want to check payer guidelines and possibly CPT assistant or other reputable sources to see if that could be reported for the acromioplasty. It does have a p2p edit w/ 23120 though.

I agree with this. If you have the access to the AAOS books, I'd take a look. Ortho can get tricky sometimes.

 

[amyjph]

Thank you so much for the detailed information, it helps with clarification. We do have the AAOS books but was not aware that CMS doesn't always agree with what is inclusive and what is not. This information will help me and the coder. I appreciate you taking the time to help me.

Yes, sometimes you can't use the AAOS books if the payer has a policy and/or NCCI guidelines prevent it, even if the specialty society disagrees.

Debridement 29822/29823 is one of the most difficult concepts for coders, I have found. It helps to outline the op report and use a "cross out" method to visualize it. Any debridement or preparation of structures done for the "greater" procedure (release biceps tendon for tenodesis, debride rotator cuff for RCR, bursectomy in the course of SAD) need to be crossed out and then you can see what you are left with. If you aren't left with three or more then it's bundled. Usually it will be the humeral head, debridement of another structure such as the labrum and possibly if no biceps tenodesis was one you could count the biceps debridement in other cases.