Wiki You be the coder ! (Simple Shoulder Surgery)

[Orthocoderpgu]

Yes, there is a reason for doing this. Experienced coders, without using EncoderPro, Codify, Google or any other program, so just using the coding knowledge you have upstairs, select the code/s that you would bill out. A doctor performed surgery and wrote down the codes for the procedures performed.

29807
29826
29822
29823

Out of these four which are billable?
You don't have to explain, just list the code/s that you would bill.
Thank you !

 

[cgaston]

I'll play!

29807
29826

 

[TThivierge]

Hi
Need to read the documentation ...not enough info.
Lady T

 

[Orthocoderpgu]

Hi
Need to read the documentation ...not enough info.
Lady T

Assume the documentation supports each code listed.

 

[amyjph]

You had me at, "doctor wrote down the codes"

 

[Orthocoderpgu]

You had me at, "doctor wrote down the codes"

I know YOU know the answer!

 

[nsteinhauser]

I'll try this.......29807, 29823, 29826......are you going to tell us the answer?

 

[Orthocoderpgu]

I'll try this.......29807, 29823, 29826......are you going to tell us the answer?

Clarence provided the correct answer. 29807 & 29826. Code 29822 cannot be billed with 29823 and 29823 cannot be billed with 29807. If you code shoulder surgeries you have this at the top of your head. No need to check the NCCI edits. I was hoping to get more coders listing the two codes that are allowed. Oh, 29826 is an "Add-on" code and can't bundle with 29807.

 

[nsteinhauser]

Thank you! Can you explain why the 29823 can't be billed with the 29807? Is it just "can't be billed with the SLAP repair" or does it need to be billed as a stand alone?
And - I thought the 29826 could be an "add-on" to the 29823.
Thanks for any info!!!

 

[Orthocoderpgu]

Thank you! Can you explain why the 29823 can't be billed with the 29807? Is it just "can't be billed with the SLAP repair" or does it need to be billed as a stand alone?
And - I thought the 29826 could be an "add-on" to the 29823.
Thanks for any info!!!

If you have access to EncoderPro, Codify or any other program with the NCCI edits built in, you will see that 29823 hits edits will all codes in the arthroscopic shoulder section except 29824, 29827 and 29828. Since CMS considers the shoulder as one anatomical location, modifier -59 can't be used. The knee is divided into three compartments, the shoulder is basically considered one compartment or area.

 

[amyjph]

See the NCCI manual Chapter 4 Musculoskeletal, pg 6: "7. Shoulder arthroscopy procedures include limited debridement (e.g., CPT code 29822) even if the limited debridement is performed in a different area of the same shoulder than the other procedure. With 3 exceptions, shoulder arthroscopy procedures include extensive debridement (e.g., CPT code 29823) even if the extensive debridement is performed in a different area of the same shoulder than the other procedure. CPT codes 29824 (Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure), 29827 (Arthroscopy, shoulder, surgical; with rotator cuff repair), and 29828 (Arthroscopy,shoulder, surgical; biceps tenodesis) may be reported separately with CPT code 29823 if the extensive debridement is performed in a different area of the same shoulder."

There *could* be WC payers that allow it (possibly).

 

[nsteinhauser]

Perrfect. Thank you. For some reason I mistakenly thought 29823 was in that "OK" group (29824, 29827 + 29828).
Thank you both for your help!

 

[sls314]

If you have access to EncoderPro, Codify or any other program with the NCCI edits built in, you will see that 29823 hits edits will all codes in the arthroscopic shoulder section except 29824, 29827 and 29828. Since CMS considers the shoulder as one anatomical location, modifier -59 can't be used. The knee is divided into three compartments, the shoulder is basically considered one compartment or area.

I was so curious about this thread when I saw it posted. The first thing I did was check the NCCI edits in EncoderPro and take a guess in my head at what the answer might be.

I have no experience with ortho, so I didn't chime in on the discussion. But I was hoping I'd at least made an educated guess based on my understanding of NCCI edits.

 

[amyjph]

It's not just the P2P edits, but the NCCI manual plays a part too. This was something I didn't understand or fully grasp when I was new to coding. Learning the manual really helped me back then. For example, if you run 29823 and 29807 through an edit checker, it shows a modifier may be allowed. This might lead some to append a 59 and report both in the same shoulder. A coder would have to understand that just because a 59 may be allowed you can't append it in this case for the same shoulder because of the manual.

 

[sls314]

It's not just the P2P edits, but the NCCI manual plays a part too. This was something I didn't understand or fully grasp when I was new to coding. Learning the manual really helped me back then. For example, if you run 29823 and 29807 through an edit checker, it shows a modifier may be allowed. This might lead some to append a 59 and report both in the same shoulder. A coder would have to understand that just because a 59 may be allowed you can't append it in this case for the same shoulder because of the manual.

Definitely. Just because a modifier could be used on a code pair doesn't mean it is always appropriate to use it.