Wiki 29824 - Arthroscopic distal claviculectomy

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mwickham

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I am needing some help with an appeal. The insurance is Humana Medicare Choice PPO. I billed 29824 and 29826. First, they requested medical records before processing the claim. I submitted the records. They denied the claim stating the services were not documented in the medical record. I submitted an appeal and attached the op report. They denied the appeal stating the procedures were not documented. I've attached the procedure detail from the op report below. I can submit a level 2 dispute but I'm really not sure how to argue that it is documented. Can anyone help shed some light on this for me? Are there any resources for the documentation requirements for this procedure? Thanks in advance for the help!

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1. Your surgeon indicated there was 1cm x 1cm portion of the distal clavicle was removed, CPT 29824 describes the performance.
2. Check any documentation to support 29826 that indicated the surgeon converted the acromion to a morphology ( type 1 to 3).

I don't do billing. Hope my note can help you to get a clear picture for these 2 CPT codes.

When I assign 29824 and 29826, I ask myself if I see these in op report:
1. arthroscopic procedure?
2. perform on distal clavicle , size of removal is > 1 cm?
3. acromioplasty is performed ? morphology of acromion ( type 1 to 3) is indicated?
 
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mwickham said:
I am needing some help with an appeal. The insurance is Humana Medicare Choice PPO. I billed 29824 and 29826. First, they requested medical records before processing the claim. I submitted the records. They denied the claim stating the services were not documented in the medical record. I submitted an appeal and attached the op report. They denied the appeal stating the procedures were not documented. I've attached the procedure detail from the op report below. I can submit a level 2 dispute but I'm really not sure how to argue that it is documented. Can anyone help shed some light on this for me? Are there any resources for the documentation requirements for this procedure? Thanks in advance for the help!

View attachment 5155
View attachment 5156
Click to expand...
I agree that it's clear that 29824 was completed, but I know that 29826 is not on the Medicare Fee Schedule for an ASC. However, I'm not sure if you work at an ASC or not, or if 29826 is on the MCR fee schedule for your type of facility. I recommended posting this in the billing forum as well.
 
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such78 said:
1. Your surgeon indicated there was 1cm x 1cm portion of the distal clavicle was removed, CPT 29824 describes the performance.
2. Check any documentation to support 29826 that indicated the surgeon converted the acromion to a morphology ( type 1 to 3).

I don't do billing. Hope my note can help you to get a clear picture for these 2 CPT codes.

When I assign 29824 and 29826, I ask myself if I see these in op report:
1. arthroscopic procedure?
2. perform on distal clavicle , size of removal is > 1 cm?
3. acromioplasty is performed ? morphology of acromion ( type 1 to 3) is indicated?
Click to expand...

Dear, further in regard to your 2nd point (perform on distal clavicle , size of removal is > 1 cm?), I am looking for clear CMS/AMA/CPT guidelines for billing claviculectomy (open/arthroscopic). I saw similar reference on one the AAPC comments where it says, “To qualify for the reimbursement of Claviculectomy, documentation should support the removal of 8-10 mm from the distal clavicle/joint.”

Appreciate if anyone clarifies on the updated CMS/AMA/CPT guidelines from the authentic source.

Thanks & Regards,
Silas
 
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