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29826 - I have a couple of question

  1. #1
    Default 29826 - I have a couple of question
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    I have a couple of question regarding the 29826.

    1.
    Can 29826 only be billed with 29806-29825, 29827 and 29828? Or is it a stand alone code when bill with all codes except the ones listed above. I ask because in our NCCI edits book 23410/23412, 298261; 29826, 298221.
    2.
    Is this the correct way to bill an open RCR (23410/23412) and arthroscopic SAD?
    23410/23412 and 23822/29823,22
    I want to make sure I am interpreting the information correctly.
    http://www.aaos.org/news/aaosnow/jan12/managing4.asp
    3.
    Since 29826 is now an add-on code, it should be modifier 51 exempt. However 2012 CPT® book states on pg 145 (top right side of pg) "When arthroscopic subacromial decompression is performed at the same setting, use 29826 and append modifier 51". I thought modifier 51 was never to be applied to an add-on code? Does this only apply when billing 29827 and 29826 together?

  2. Default
    Quote Originally Posted by cbeuerlein View Post
    I have a couple of question regarding the 29826.

    1.
    Can 29826 only be billed with 29806-29825, 29827 and 29828? Or is it a stand alone code when bill with all codes except the ones listed above. I ask because in our NCCI edits book 23410/23412, 298261; 29826, 298221.
    2.
    Is this the correct way to bill an open RCR (23410/23412) and arthroscopic SAD?
    23410/23412 and 23822/29823,22
    I want to make sure I am interpreting the information correctly.
    http://www.aaos.org/news/aaosnow/jan12/managing4.asp
    3.
    Since 29826 is now an add-on code, it should be modifier 51 exempt. However 2012 CPT® book states on pg 145 (top right side of pg) "When arthroscopic subacromial decompression is performed at the same setting, use 29826 and append modifier 51". I thought modifier 51 was never to be applied to an add-on code? Does this only apply when billing 29827 and 29826 together?
    After 29826 in the CPT manual it says "Code first 29806-29825, 29827-29828". This means 29826 can only be billed if one of those codes is billed also. It is now an add-on code, as stated in your #3 question, and not a stand-alone code, as asked in your #1 question. 29826 cannot be billed with 23410 or 23412 any longer, even with modifer -59.
    If a decompresson of subacromial space with partial acromioplasty is performed with open RCR you can represent this with 29822 or 29823, and modifier -22 can be added to the debridement code if documentation supports.
    You are correct that modifier -51 should not be used on 29826 now that it's an add-on code. Page 145 in my 2012 CPT manual is splenic & bone marrow procedures...so I'm not sure where to look for the reference of appending -51 to 29826. There may be left-over info from last year, but you're correct...it is an error.
    Oh and one more thing...if you find that your Doc has performed a 29826 alone...nothing else done...it now must be represented by an unlisted code and use the charge for 29826 from 2011. Makes sense? Good luck!
    Jenna

  3. #3
    Default
    Quote Originally Posted by JMeggett View Post
    After 29826 in the CPT manual it says "Code first 29806-29825, 29827-29828". This means 29826 can only be billed if one of those codes is billed also. It is now an add-on code, as stated in your #3 question, and not a stand-alone code, as asked in your #1 question. 29826 cannot be billed with 23410 or 23412 any longer, even with modifer -59.
    If a decompresson of subacromial space with partial acromioplasty is performed with open RCR you can represent this with 29822 or 29823, and modifier -22 can be added to the debridement code if documentation supports.
    You are correct that modifier -51 should not be used on 29826 now that it's an add-on code. Page 145 in my 2012 CPT manual is splenic & bone marrow procedures...so I'm not sure where to look for the reference of appending -51 to 29826. There may be left-over info from last year, but you're correct...it is an error.
    Oh and one more thing...if you find that your Doc has performed a 29826 alone...nothing else done...it now must be represented by an unlisted code and use the charge for 29826 from 2011. Makes sense? Good luck!
    Jenna
    The reference of pg 145 was in the cpt professinal edition after 29827 and diagram of 29824 (top right side of pg) was where the statement of "When arthroscopic subacromial decompression is performed at the same setting, use 29826 and append modifier 51". It is listed in parentheses. The state of appending modifier 51 to an add-on code goes against everything.

    Thanks for the other information.

  4. Default
    how come CPT manual it does say to use 29826 in addition to say 29806
    but when I enter these two together I get an edit saying cannot be billed together unless modifier applied which doesnt even make sense since 29826 is an add-on code and cant use modifier.

    Am I correct that we can bill these 2 together?

  5. Default
    Quote Originally Posted by nabernhardt View Post
    how come CPT manual it does say to use 29826 in addition to say 29806
    but when I enter these two together I get an edit saying cannot be billed together unless modifier applied which doesnt even make sense since 29826 is an add-on code and cant use modifier.

    Am I correct that we can bill these 2 together?
    You are correct that you can bill 29806 & 29826 together, and if that's all that being done then no modifier is needed. I cannot speak, however, for the edit software in your system. Has it been updated to accomodate the CPT changes for 2012?

    Jenna

  6. #6
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    Default
    Quote Originally Posted by JMeggett View Post
    You are correct that you can bill 29806 & 29826 together, and if that's all that being done then no modifier is needed. I cannot speak, however, for the edit software in your system. Has it been updated to accomodate the CPT changes for 2012?

    Jenna
    I believe CCI edits bundle these 2 codes...

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