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Rcr w/ total shoulder

  1. #1
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    Talking Rcr w/ total shoulder
    Medical Coding Books
    I need a little input here. when a dr peforms a total shoulder and rotator cuff repair (RCR) do you bill out both AND get paid? I always follow the NCCI edits and ONLY bill out with a 59 mod if the dr CLEARLY documents a separate issue.

    Am I wrong? Can you always bill out a RCR with a Total Shoulder and just add 59 mod to bypass edit?

    I a little confused on this. Thanks....

  2. #2
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    my personal opinion....it bundles per NCCI....I've never seen documentation that would/could warrant the justification of bypassing the edits with a 59 modifier.

    Mary, CPC, COSC

  3. #3
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    I agree with that...but now I'm being told that AAOC states we can bill out the RCR with a Total Shoulder and I'm now instructed to do so. I didn't find any articles (still looking) on the AAOS website. That's why I figured I'd ask around.

    Thanks..

  4. #4
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    Quote Originally Posted by nyyankees View Post
    I agree with that...but now I'm being told that AAOC states we can bill out the RCR with a Total Shoulder and I'm now instructed to do so. I didn't find any articles (still looking) on the AAOS website. That's why I figured I'd ask around.

    Thanks..
    If you find something please post..I'd love to be able to capture it

  5. #5
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    Will do..

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