AAPC - Back to school
Results 1 to 3 of 3

Thread: Shoulder surgery

  1. #1
    Join Date
    Apr 2007
    Mountain Home, AR

    Question Shoulder surgery

    AAPC: Back to School
    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?


  2. #2

    Default mod 59

    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.

  3. #3
    Join Date
    Apr 2007


    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

Similar Threads

  1. Help on shoulder surgery
    By amartinez1 in forum Orthopaedics
    Replies: 2
    Last Post: 05-21-2012, 08:45 AM
  2. Help with shoulder surgery
    By amartinez1 in forum Orthopaedics
    Replies: 1
    Last Post: 01-04-2011, 05:14 AM
  3. Shoulder surgery - new one
    By Desperate Denise in forum Orthopaedics
    Replies: 4
    Last Post: 01-26-2010, 11:53 AM
  4. Need help with shoulder surgery
    By CJoy0724 in forum Orthopaedics
    Replies: 0
    Last Post: 12-30-2009, 07:01 AM
  5. shoulder surgery - We don't do many shoulder surgeries
    By elenax in forum Outpatient Facilities
    Replies: 3
    Last Post: 07-29-2009, 05:28 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.