shoulder surgery - Need a little help in the new CPT

hlmcintyre

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Need a little help in the new CPT code 29826 update. My physician did a right shoulder arthroscopy, subacromial decompression and debridement of labral tear. I know 29826 cannot stand alone. 29822 is bundled in 29826. so, do i use just the 29822 with no 29826. I read other places where you use an unlisted code 29999 but in other articles I have read the AAOS and the AMA state instead of the 29826 use the 29822 or 29823. Has any one else come across this? What is right? Need you help please. Thanks
 

JMeggett

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Need a little help in the new CPT code 29826 update. My physician did a right shoulder arthroscopy, subacromial decompression and debridement of labral tear. I know 29826 cannot stand alone. 29822 is bundled in 29826. so, do i use just the 29822 with no 29826. I read other places where you use an unlisted code 29999 but in other articles I have read the AAOS and the AMA state instead of the 29826 use the 29822 or 29823. Has any one else come across this? What is right? Need you help please. Thanks
If this is a Medicare patient they state you can't bill the two of the codes so you are stuck with 29822.
If it's a commercial carrier and they follow CPT guidelines it states you could bill 29822 and 29826 and no modifiers are needed.
However if the payer uses CCI edits they may require a modifier since CCI is keeping their edit as:
"Code 29822 is a component of Column 1 code 29826 but a modifier is allowed in order to differentiate between the services provided. " Make sense?

Jenna
 

hlmcintyre

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thanks Jenna. The new changes to the CPT 29826 is confusing as it is an add-on code now and especially when it is done by itself and the 29822 is included in with the 29826 CCI so i wasn't sure if anyone else had come across this. Thanks for your help. I appreciate it.
 
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