Wiki 29870 with an open code?

[ahodge90]

I have an issue that is being debated in our clinic, and am curious what other coders have to say about this.
we have a case where a provider did a diagnostic scope first and then did a lateral release. we ran the NCCI edits and they are not coming up as bundled, but there is that parenthetical with 29870 that says separate procedure. My impression of this parenthetical is that if this is done on the same anatomical area they cannot be billed separately. BUT there is something that I found from what looks like an older appc presentation that makes me wonder if they can be billed together.

Can anyone help me understand this so that I can help my clinic better understand this? Can we bill the diagnostic code with an open procedure, when it was NOT converted to open?

 

[Orthocoderpgu]

Any and every surgical procedure starts with a diagnostic examination of the joint/area that will be worked on. There are two issues here. First is that you can never bill for a diagnostic examination of any joint/area that will be worked on. Not matter if the restorative procedure is performed open or arthroscopic. Your going to "Look before you leap" and I have seen many times where the procedure/s have changed after the diagnostic exam. That's when the surgeon really "finalizes" the restorative procedure/s performed. Now, can you bill a code marked as a "separate procedure' with another code? Yes, if it's truly unrelated. You don't see this very often, but it does happen occasionally. I hope this helps.

 

[ahodge90]

Any and every surgical procedure starts with a diagnostic examination of the joint/area that will be worked on. There are two issues here. First is that you can never bill for a diagnostic examination of any joint/area that will be worked on. Not matter if the restorative procedure is performed open or arthroscopic. Your going to "Look before you leap" and I have seen many times where the procedure/s have changed after the diagnostic exam. That's when the surgeon really "finalizes" the restorative procedure/s performed. Now, can you bill a code marked as a "separate procedure' with another code? Yes, if it's truly unrelated. You don't see this very often, but it does happen occasionally. I hope this helps.

This is very helpful and it most definitely helped clarify and confirm things for me. Thank you!