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29823 with 29826

  1. Default 29823 with 29826
    Medical Coding Books
    Here we go again with the shoulder ---

    Can you should experts conform with me that both docs in both situations can bill 29826 and 29823 with modifier 59. I sometimes get confuse cuz the edits state I cannot bill 29823 with 29826 and the docs say that they can cuz the debridement (29823) was back and front. Do you guys feel that in both cases that 29823 is okay to bill to BLUE SHIELD and that the MODIFIER 59 is okay.

    THANK YOU SOOOO MUCH !!!!! Denise

    OPERATIVE REPORT #1

    POSTOPERATIVE DIAGNOSIS:
    1. Left shoulder rotator cuff tear.
    2. Impingement syndrome.
    3. Labral tear.

    OPERATION PERFORMED:
    1. Left shoulder arthroscopy,
    2. Partial rotator cuff tear debridement, type 1 labral debridement 29823-59
    3. Subacromial decompression. 29826

    DESCRIPTION OF PROCEDURE: The patient was brought to the operating room, placed supine on the operating table. After induction of general anesthetic and interscalene block, she was placed in the beach-chair position. All bony prominences were padded. Her left shoulder was prepped and draped in a standard surgical fashion. A posterior portal was created. Examination of the joints showed no glenohumeral articular surfaces. There was a 10% tear of the supraspinatus tendon which was debrided with a 35-mm fulgurated shaver. Biceps anchor showed type 1
    labral tear and it was debrided with 35-mm fulgurated shaver.

    Attention was directed to the subacromial space where the rotator cuff was intact from above. Subacromial decompression was carried out arthroscopically.


    OPERATIVE REPORT #2

    POSTOPERATIVE DIAGNOSIS:
    1. Right shoulder pain.
    2. Right shoulder posterior labral tear.
    3. Right shoulder glenohumeral joint arthritis.
    4. Right shoulder impingement.

    OPERATION PERFORMED:
    1. Right shoulder arthroscopy.
    2. Right shoulder debridement. 29823-59
    3. Right shoulder subacromial decompression. 29826


    DESCRIPTION OF PROCEDURE: The patient was brought to the preoperative
    area. The site and side were identified. Then an interscalene block was
    administered. He was then brought in the operating room, placed supine on
    the operating room table. Bony prominences were padded appropriately.
    General endotracheal intubation was performed. He was then placed in the
    beach chair position. Examination of the right shoulder under anesthesia
    revealed full passive range of motion in all planes. The right upper
    extremity was prepped and draped in a sterile fashion. Bony landmarks of
    the shoulder including posterolateral, lateral and anterior lateral aspect
    of the acromion, AC joint and coracoid process were marked with a marking
    pen. Then a mark was made 2 fingerbreadths down, 2 fingerbreadths medial
    from the posterolateral aspect of the acromion.

    An 18 gauge spinal needle was inserted into the glenohumeral joint. The
    joint was distended with 60 mL of sterile saline. An 11 blade scalpel was
    used to incise the skin and the arthroscope was introduced in the
    posterior aspect of the glenohumeral joint. There was evidence of a large
    flap tear off the posterior labrum. This was interposed between the
    glenoid and humeral surfaces. There was evidence of grade 2
    chondromalacia changes over the humeral head. There was evidence of grade
    2 chondromalacia changes over the glenoid surface, particularly over the
    posterior inferior margin there was grade 3-4 changes. There was no
    evidence of superior labral tear. The biceps tendon was in good
    condition. The subscapularis muscle was in good condition. The
    supraspinatus, infraspinatus and teres minor appeared intact with no
    evidence of tearing or fraying. No evidence of loose bodies within the
    axillary pouch.

    An anterior portal was established using outside in technique. An 18
    gauge spinal needle was inserted above the superior border of the
    subscapularis muscle. An 11 blade scalpel was used to incise the skin. A
    7-mm cannula was introduced in the glenohumeral joint. The posterior
    labral flap was debrided. The labrum itself appeared to be well attached
    to the superior and anterior aspect of the glenoid. The biceps tendon was
    brought into the glenohumeral joint area. The rotator cuff and
    subscapularis muscle were inspected in their entirety. A posterior
    working portal was established and the camera was switched to the anterior
    portion. The posterior labrum was viewed, it was felt to be more frayed
    than detached and once again there was evidence of arthritic
    chondromalacia over the posterior inferior glenoid surface. Once all
    intra-articular work was complete, the arthroscope from the glenohumeral
    joint and introduced in the subacromial space. There was evidence of
    bursitis. A complete bursectomy was performed. The rotator cuff was
    cleared of all soft tissue. The coracoacromial ligament was released.
    The undersurface of the acromion was cleared of all soft tissue. Using a
    4-0 acromionizer bur a subacromial decompression was performed. Once this
    was complete, the arm was brought through internal and external rotation
    and there was no evidence of bursal sided rotator cuff tearing. Once all
    work was complete all arthroscopic instrumentation was removed from the
    subacromial space.

  2. #2
    Location
    Long Island/New York
    Posts
    1,271
    Default
    i don't see any debridement documented.... di they debride the labrum and humeral head?

  3. Default
    Yes, I would code both of these as 29826 and 29823.
    Oh and I copied and pasted and highlighted what the AAOS code X software for 2010 says about 29823 with 29826. says 29823 does not include 29826 so therefore they can be billed together.


    CPT Code: 29823

    Arthroscopy, shoulder, surgical; debridement, extensive

    Intraoperative services included in the global service package:

    1. local infiltration of medication(s), anesthetic, or contrast agent before, during, or at the conclusion of the operation
    2. suture or staple removal by operating surgeon or designee
    3. surgical approach, with necessary identification, isolation, and protection of anatomic structures, including hemostasis and minor skin scar revision
    4. obtaining wound specimen(s) for culture
    5. wound irrigation
    6. intraoperative photo(s) and/or video recording, excluding ionizing radiation
    7. intraoperative supervision and positioning of imaging and/or monitoring equipment by operating surgeon or assistant(s)
    8. insertion, placement, and removal of surgical drain(s), re-infusion device(s), irrigation tube(s), or catheter(s)
    9. closure of wound and repair of tissues divided for initial surgical exposure, partial or complete
    10. application of initial dressing, orthosis, continuous passive motion, splint or cast, including traction, except where specifically excluded from global package
    11. synovectomy (eg, 23105, 29820)
    12. arthroscopic debridement of labrum and/or SLAP lesion, limited (eg, 29822)
    13. shoulder arthroscopy, diagnostic (eg, 29805)
    14. arthroscopic lysis of adhesions (eg, 29825)
    15. manipulation under anesthesia (eg, 23700)

    Intraoperative services not included in the global service package:

    1. supplies and medication (eg, code 99070, HCPCS Level II codes)
    2. insertion, removal, or exchange of nonbiodegradable drug delivery implants (eg, 11981–11983)
    3. arthroscopic acromioplasty (eg, 29826)
    4. arthroscopic removal of loose or foreign bodies greater than 5 mm or through separate incision (eg, 29819)
    5. arthroscopic repair of rotator cuff (eg, 29827)
    6. arthroscopic distal clavicle excision (eg, 29824)
    7. arthroscopic biceps tenodesis (eg, 29828)

    Medicare global fee period: 90 days

  4. Default
    Quote Originally Posted by Desperate Denise View Post
    Here we go again with the shoulder ---

    Can you should experts conform with me that both docs in both situations can bill 29826 and 29823 with modifier 59. I sometimes get confuse cuz the edits state I cannot bill 29823 with 29826 and the docs say that they can cuz the debridement (29823) was back and front. Do you guys feel that in both cases that 29823 is okay to bill to BLUE SHIELD and that the MODIFIER 59 is okay.

    THANK YOU SOOOO MUCH !!!!! Denise

    OPERATIVE REPORT #1

    POSTOPERATIVE DIAGNOSIS:
    1. Left shoulder rotator cuff tear.
    2. Impingement syndrome.
    3. Labral tear.

    OPERATION PERFORMED:
    1. Left shoulder arthroscopy,
    2. Partial rotator cuff tear debridement, type 1 labral debridement 29823-59
    3. Subacromial decompression. 29826

    DESCRIPTION OF PROCEDURE: The patient was brought to the operating room, placed supine on the operating table. After induction of general anesthetic and interscalene block, she was placed in the beach-chair position. All bony prominences were padded. Her left shoulder was prepped and draped in a standard surgical fashion. A posterior portal was created. Examination of the joints showed no glenohumeral articular surfaces. There was a 10% tear of the supraspinatus tendon which was debrided with a 35-mm fulgurated shaver. Biceps anchor showed type 1
    labral tear and it was debrided with 35-mm fulgurated shaver.

    Attention was directed to the subacromial space where the rotator cuff was intact from above. Subacromial decompression was carried out arthroscopically.


    OPERATIVE REPORT #2

    POSTOPERATIVE DIAGNOSIS:
    1. Right shoulder pain.
    2. Right shoulder posterior labral tear.
    3. Right shoulder glenohumeral joint arthritis.
    4. Right shoulder impingement.

    OPERATION PERFORMED:
    1. Right shoulder arthroscopy.
    2. Right shoulder debridement. 29823-59
    3. Right shoulder subacromial decompression. 29826


    DESCRIPTION OF PROCEDURE: The patient was brought to the preoperative
    area. The site and side were identified. Then an interscalene block was
    administered. He was then brought in the operating room, placed supine on
    the operating room table. Bony prominences were padded appropriately.
    General endotracheal intubation was performed. He was then placed in the
    beach chair position. Examination of the right shoulder under anesthesia
    revealed full passive range of motion in all planes. The right upper
    extremity was prepped and draped in a sterile fashion. Bony landmarks of
    the shoulder including posterolateral, lateral and anterior lateral aspect
    of the acromion, AC joint and coracoid process were marked with a marking
    pen. Then a mark was made 2 fingerbreadths down, 2 fingerbreadths medial
    from the posterolateral aspect of the acromion.

    An 18 gauge spinal needle was inserted into the glenohumeral joint. The
    joint was distended with 60 mL of sterile saline. An 11 blade scalpel was
    used to incise the skin and the arthroscope was introduced in the
    posterior aspect of the glenohumeral joint. There was evidence of a large
    flap tear off the posterior labrum. This was interposed between the
    glenoid and humeral surfaces.
    There was evidence of grade 2
    chondromalacia changes over the humeral head. There was evidence of grade
    2 chondromalacia changes over the glenoid surface, particularly over the
    posterior inferior margin there was grade 3-4 changes. There was no
    evidence of superior labral tear. The biceps tendon was in good
    condition. The subscapularis muscle was in good condition. The
    supraspinatus, infraspinatus and teres minor appeared intact with no
    evidence of tearing or fraying. No evidence of loose bodies within the
    axillary pouch.

    An anterior portal was established using outside in technique. An 18
    gauge spinal needle was inserted above the superior border of the
    subscapularis muscle. An 11 blade scalpel was used to incise the skin. A
    7-mm cannula was introduced in the glenohumeral joint. The posterior
    labral flap was debrided. The labrum itself appeared to be well attached
    to the superior and anterior aspect of the glenoid. The biceps tendon was
    brought into the glenohumeral joint area. The rotator cuff and
    subscapularis muscle were inspected in their entirety. A posterior
    working portal was established and the camera was switched to the anterior
    portion. The posterior labrum was viewed, it was felt to be more frayed
    than detached and once again there was evidence of arthritic
    chondromalacia over the posterior inferior glenoid surface. Once all
    intra-articular work was complete, the arthroscope from the glenohumeral
    joint and introduced in the subacromial space. There was evidence of
    bursitis. A complete bursectomy was performed. The rotator cuff was
    cleared of all soft tissue. The coracoacromial ligament was released.
    The undersurface of the acromion was cleared of all soft tissue. Using a
    4-0 acromionizer bur a subacromial decompression was performed. Once this
    was complete, the arm was brought through internal and external rotation
    and there was no evidence of bursal sided rotator cuff tearing. Once all
    work was complete all arthroscopic instrumentation was removed from the
    subacromial space.
    I highlighted in her notes where the debridement was.
    On the second note the first part I highlighted goes with the second part that I highlighted were the debridement was.

  5. Default Bella -
    Bella - you certainly live up to your name - expert - I think after a year I finally get the shoulder stuff - I just got so confused after speaking to the coding person at the AAOS. It really confused me.

    Thank you so very much for sharing your expertise - you are awesome.

    Have a great day!!

  6. Default
    Quote Originally Posted by Desperate Denise View Post
    Bella - you certainly live up to your name - expert - I think after a year I finally get the shoulder stuff - I just got so confused after speaking to the coding person at the AAOS. It really confused me.

    Thank you so very much for sharing your expertise - you are awesome.

    Have a great day!!
    Your welcome and thank you very much...I'm happy to help.
    Also, I'm glad you're getting the hang of it.
    You have a great day too!!!

  7. Default
    according to the "orthopedic Coding Alert" 08/2010 you can bill both 29823 and 29826 using -59 since each px is a separate muscle.

    BY in LR

  8. Default 29823 with 29826
    Hello,

    I'm new to this forum and can't seem to find how to start a new thread question. I know that these two codes are not bundled according to the CCI Edits, but I am on the ASC side and we are just now getting rejections stating that these two codes are bundled for the ASC. We cannot find anything stating that and have appealed these claims already. We are told by the repricing company that their edit program is for the ASC, but will not divulge what program it is. Please help.

  9. #9
    Default
    Quote Originally Posted by kristimc434 View Post
    Hello,

    I'm new to this forum and can't seem to find how to start a new thread question. I know that these two codes are not bundled according to the CCI Edits, but I am on the ASC side and we are just now getting rejections stating that these two codes are bundled for the ASC. We cannot find anything stating that and have appealed these claims already. We are told by the repricing company that their edit program is for the ASC, but will not divulge what program it is. Please help.

    29826 has an ASC status indicator of N1 which means "Packaged service/item; no separate payment made". Usually add-on codes have this status and the ASC payment is made on the parent code
    CPC-P-A (11/2016), COC-A (9/2016), CPC-A (11/2015), PAHM (2010)
    Fee Schedule Configuration Specialist - Remote

    15 years health insurance experience: Audit, Claims, Customer Service, Payment Policy, Provider Relations, and Reimbursement

  10. Default
    Thank you, so much!

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