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29827,29826,29824 modifier ????

  1. #1
    Location
    Pensacola , Florida
    Posts
    122
    Default 29827,29826,29824 modifier ????
    Medical Coding Books
    Is it necessary to use a modifier for any of these - I know I have read that it was not necessary but I am being challenged by a payer and my mind is totally blank ...

    He says that the 29827 & 29826 are exactly the same through only one portal ...not two...but it is two right ?

    Can someone please help me ? I need to know if I need to do a correction and if not please help me understand why it is not necessary to append a modifier ?

    Thanks

    I am feeling so overwhelmed - and not sure of anything any more ...bad bad place to be in - + being alone is not so great after all !!
    Last edited by Justarose; 03-17-2009 at 09:38 AM. Reason: added something

  2. #2
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    have you checked the CCI Edits?
    http://www.cms.hhs.gov/NationalCorrectCodInitEd/
    Donna, CPC, CPC-H

  3. Default
    Hi Rie, Though different payors have different rules,according to CPT guideline, you should append Modifier 51 when performed at same session.

  4. #4
    Location
    Pensacola , Florida
    Posts
    122
    Default Hey Lyssis : )
    Thanks ...but please help with this ? .. I didn't think modifier 51 was allowed for an ASC ? Am I wrong on that ??? OY!

  5. #5
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    that is correct. Modifier 51 is not an ASC modifier, it is a physician modifier.

    Modifier 59 would not be required on any of these codes when billed together..UNLESS your payor has other guidelines. The only modifier I would use would be RT/LT.

    I would request that the payor send you something in writing indicating where they are getting there information or request a supervisor and fight it!!

    Mary, CPC, COSC

  6. #6
    Location
    Pensacola , Florida
    Posts
    122
    Unhappy Mary ...one more question
    Thank you so much for that clarification !

    meanwhile I found this in an old orthopedic coding alert..
    it says " You should not report the subscapularis repair separately because it is one of the rotator cuff tendons. You should include the repair in RCR code 29827"


    It goes on to quote this "The AMA's March 2008 CPT Assistant states that when the surgeon makes and additional portal to repair the subscapularis tendon during an arthroscopic RCE , you should NOT report the additional portal separately. Code 29827 represents the repair of one, two , or three tendons. The number of portals made does not alter the use of code 29827" per the CPT assistant ...

    I am so confused !!! Please tell me your thoughts - am I reading this wrong ?

  7. #7
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    that is correct. 29826 is for subacromial decompression (bony work) and is totally different than 29827 (tendon work)

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