Wiki 29862 and 29863 in the same procedure

[svannortwick]

My surgeon is billing both 29862-RT (arthroscopy, hip; with debridement of articular cartilage) and 29863-RT (arthroscopy, hip; with synovectomy) with the diagnosis of M24.151 (Other articular cartilage disorders, right hip) for the same procedure and I'm receiving a denial from HAP stating that the chondroplasty is included in the synovectomy (I would think its the other way around?). I know they are not an NCCI pair, which is what HAP is telling me is the reason for the denial? Any thoughts on how to get these paid separately, or are they truly inclusive? Should I just give in and report a 59 modifier? The procedure is done through the same incision but he's trying to tell me that since each procedure is for a separate structure they should be payable. I'm still new to this specialty and struggling pretty hard with this provider.

 

[Orthocoderpgu]

If you are linking M24.151 with 29863 I think that may be your issue.

 

[kimberlywatson]

I agree with the above comment. That diagnosis would not warrant 29863.

Also, welcome to ortho! I'm happy to help if you ever have questions.