Wiki Shoulder surgery

[ozarkortho]

I had a patient that is Medicare and had a shoulder debridment and open rotator cuff. It was billed as follows:
23412 - RT and 29823 - 59,RT. Medicare did not pay the second procedure at full fee, but used (51) in order to see it as a multiple. Any thoughts?

Thanks!

 

[jruffini]

mod 59

hi
per mcare guidelines "modifier 59 never to be used"
if you read requirements for using 59, even if the surgery
has 2 seperate procedures, 51 applies.
i'm surprised mcare did not flat out deny 29823 59RT(arthoscopy)
also, are you sure the md did "open" & "Arthoscopy" same day?
59 would apply if seperate procedure done same of different day.
joe

 

[mbort]

since the 29823 does not bundle with 23412, the modifier 59 would not be appropriate in this particular case. In addition, 29823 is not modifier 51 exempt so they will not pay the procedure at 100% per Medicare payment guidelines.

Hope this helps--Watch those CCI edits for overuse of the -59 modifier--it will get you in HOT HOT water

Mary, CPC,COSC