Orthopedic Coding Alert

Question: One of our surgeons frequently performs multiple arthroscopic procedures on shoulders. There are no CPT codes for the following: arthroscopic anterior capsular labral reconstruction arthroscopic posterior capsular reconstruction, and inferior capsular plication. We use 29909. Can we report it multiple times? Would the above three procedures be considered one, two or possibly three separate procedures? The arthroscopic anterior labral reconstruction compares to open code 23455, but what would the other procedures compare to if billed separately? And if 29909 is used more than one time, should modifier -59 be attached?

Texas Subscriber

Answer: When multiple unlisted arthroscopic procedures are performed at the same anatomic site, you only need to report 29909 (unlisted procedure, arthroscopy) once. Review the available analogous codes with your surgeon and have him or her select the ones that are best suited for comparison and explain why. This information should be communicated to the carrier in a letter clearly describing the procedures that were performed, comparing them to the existing codes chosen by the surgeon and citing any increased complexity with the arthroscopic approach. The operative report should also be submitted with the claim. Do not hesitate to request a specific, reasonable level of reimbursement to the carrier.