Wiki 29915 and 29916

[pochranek]

Our physician dis a hip arthroscopy anterior labral repair lateral labral debridement with major synovectomy and acetabuloplasty

We billed it out with 29916 as the primary code and 29915 as the secondary because per the CPT book "do not report 29916 for labral repair secondary to acetabuloplasty.....) The carrier paid 29915 but denied 29916 stating inclusive.

Is it appropriate to use modifier 59 in this case?

 

[s.stringfellow@ascserves.com]

29915 CANNOT BE BILLED EVEN WITH 59 MODIFER, THE ONLY CODE BILLABLE IS 29916. SEE DESCRIPTION IN CPT BOOK.

 

[amyjph]

Chondroplasty/abrasion arthoplasty/labral resection (29862), synovectomy (29863) and acetabulopasty (29915) are included in the labral repair (29916) and cannot be coded separately.
If the main intent of the surgery and plan was for labral repair (29916) you would report that. If the main intent of the surgery was acetabulopasty (29915) you report that. It's one or the other, not both.
The payer paid the 29915 even though you listed it second because it is considered "primary" if you run NCCI edits. You should have run the edits prior to billing the case. As advised above, see the CPT description. 29916 states (do not report 29916 in conjunction with 29915, 29862, 29863). 29915 states (do not report 29914, 29915 in conjunction with 29862, 29863).
In almost every hip scope case I have seen, the reason they go in is labral repair.