Orthopedic Coding Alert
Arthroscopic SAD Edits Vary According to Source
Compare AAOS' code pairs with NCCI's before you bill 29826 Orthopedic coders know that you can't always follow just one source when it comes to component codes. Although the National Correct Coding Initiative (NCCI) dictates which codes you can and can't bill to Medicare with your main procedure, private payers often use their own rules - and don't always go by the NCCI. The AAOS does not include 29822 in the global service package for 29826. Most coding consultants agree, however, that if the surgeon merely performs limited debridement in the subacromial space, as may be the case with rotator cuff procedures, you should not report 29822 in addition to 29826.
The American Academy of Orthopaedic Surgeons (AAOS) publishes its Complete Global Service Data for Orthopaedic Surgery, which explains which procedures the AAOS believes are components of one another - and these don't always match the NCCI's policies.
The following list will help you determine which codes the NCCI bundles into 29826 (Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or without coracoacromial release).
Note that you can bill procedures that feature an asterisk (*) with 29826 if you append a modifier (such as
-59, Distinct procedural service) to denote that the surgeon's operative report demonstrates that he went above and beyond the normal service included with shoulder surgery code 29826.
NCCI bundles the following codes into 29826:
Both CPT guidelines and the AAOS state that SAD (29826) inherently includes suture removal, wound irrigation, pain pump and surgical drain insertion, wound closure and repair, and dressing, splint or cast application services.
Orthopedic Coding Alert
- Coding Case Study:
Scrutinize Op Report Before You Bill 29822 With 29826
Not every SLAP lesion debridement claim will warrant separately reporting 29822 If you bemoan coding [...] - Arthroscopic SAD Edits Vary According to Source
Compare AAOS' code pairs with NCCI's before you bill 29826 Orthopedic coders know that you [...] - Using Modifier -59 to Separate All the NCCI Edits? Think Again
The OIG plans to crack down on -59 usage in 2005, so be careful If [...] - You Be the Coder:
How Should We Report a Disk Bulge?
Question: My surgeon's operative report says,"Mild central disk bulge at L4-5 with facet and ligamentum [...] - Reader Questions:
Negative History May Mean No History
Question: When the orthopedist writes, "Past history is negative," would this satisfy the "past history" [...] - Clip and Save:
This Tool Can Do the Modifier Work for You
Use a flowchart to determine when modifier -59 best suits the bill Suppose your physician [...] - Reader Questions:
Stick With Unlisted for Meniscus Trephination
Question: Which code should I report when the orthopedist documents "arthroscopic trephination posterior third medial [...] - Reader Questions:
Look to 99141 for Conscious Sedation
Question: Especially when dealing with young children, our surgeon will administer conscious sedation during difficult [...] - Reader Questions:
Append -24 During Global With Private Payers
Question: If a patient has a postsurgical hematoma during the global period, can we bill [...] - Reader Questions:
New Decubitus Ulcer Codes Shouldn't Be Confusing
Question: I noticed that ICD-9 2005 added an "unspecified site" and "other specified" decubitus ulcer [...] - Reader Questions:
Append -21 to Level-5 E/M Only
Question: Our orthopedist performed a level-three E/M service on a new patient last week. The [...]
