# CPT 29826 not getting paid with 23412 and 29824



## Katie_Ellis (Oct 5, 2017)

Is anyone having a hard time getting paid for add on code 29826 when performed with the rotator cuff repair (23412) even if 29824 is also billed? I have been unsuccessful, mainly with Aetna, which I could not find a CPB for rotator cuff surgery. 

First the surgeon performs the arthroscopic distal claviculectomy for indications of OA (29824), then performs the subacromial decompression with acromioplasty arthroscopically for impingement and bursitis (29826-59) and finally performs the mini open rotator cuff repair for a chronic tear (23412) I asked for reconsideration and appealed with no luck.

Any insight would be appreciated.

Thank you,
Katie Ellis C.P.C.


----------



## Orthocoderpgu (Oct 5, 2017)

*29826 hits edit with 23412*

code 29826 hits edit with 23412 which is why it's not getting paid. If the rotator cuff is repaired arthroscopically, then it does not hit edit. However, you can count the subacromial decompression as debridement (29822, 29823). Keep in mind that with the changes made to the surgical policy manual this year code 29822 cannot be billed with any other arthroscopic procedure. Code 29823 can only be billed with 29824, 29827 & 29828. I would look at debridement that is not performed as preparation for a repair and add the 29826 to that and bill 29823.


----------



## Katie_Ellis (Oct 5, 2017)

Orthocoderpgu said:


> code 29826 hits edit with 23412 which is why it's not getting paid. If the rotator cuff is repaired arthroscopically, then it does not hit edit. However, you can count the subacromial decompression as debridement (29822, 29823). Keep in mind that with the changes made to the surgical policy manual this year code 29822 cannot be billed with any other arthroscopic procedure. Code 29823 can only be billed with 29824, 29827 & 29828. I would look at debridement that is not performed as preparation for a repair and add the 29826 to that and bill 29823.



So I should have just billed 23412 and 29822 or 29823 rather than the 29824 and 29826?


----------



## Orthocoderpgu (Oct 5, 2017)

*29824 is billable*

Code 29824 is billable. It does not hit an edit. But 29826 for the SAD does. So you could bill out 23412, 29823, 29824.

Code 29822 still hits an edit with these codes because limited debridement is included with any shoulder procedure. So you would have to really see if 29823 is warranted. Since the subacromial area had bursitis and there was impingement, so the acromion was debrided, it probably is.


----------



## Kati Haughton (Jan 31, 2021)

Orthocoderpgu said:


> *29824 is billable*
> 
> Code 29824 is billable. It does not hit an edit. But 29826 for the SAD does. So you could bill out 23412, 29823, 29824.
> 
> Code 29822 still hits an edit with these codes because limited debridement is included with any shoulder procedure. So you would have to really see if 29823 is warranted. Since the subacromial area had bursitis and there was impingement, so the acromion was debrided, it probably is.


I have had this same problem but only with Aetna. Could you bill 23412, 29824 and 29826-59?


----------



## Orthocoderpgu (Jan 31, 2021)

Kati Achey said:


> I have had this same problem but only with Aetna. Could you bill 23412, 29824 and 29826-59?


No because the NCCI edits does not allow modifier -59 with shoulder surgeries since CMS considers the shoulder to be one anatomical location. You used to be able to code this way, but not any longer.


----------



## klienhart (Jan 31, 2021)

I agree with Orthocoderpgu - depending on how much debridement is performed you can bill 29823.  If 29823 is not supported, then I append modifier 22 to 23410/23412 to account for the arthroscopic work, which I believe it is in an issue of AAPC monthly, December 2019, where it states you can append modifier 22 for the scope work.


----------

