Wiki Arthroscopic biceps tenotomy denials

[kdsampson]

Just checking to see if anyone that has billed 29999 for biceps tentomies are seeing denials with Medicare.

We were billing this and getting payment, but we are now starting to see denials from Medicare for being bundled into other arthroscopic procedures. I'm assuming we are seeing these due to the new CCI rules that started this year not allowing 59 modifier to be added to a shoulder code that is bundled into another procedure.

Any input is appreciated.

Thanks!

Kimberly Sampson, CPC
Insurance Coordinator

 

[nyyankees]

Just checking to see if anyone that has billed 29999 for biceps tentomies are seeing denials with Medicare.

We were billing this and getting payment, but we are now starting to see denials from Medicare for being bundled into other arthroscopic procedures. I'm assuming we are seeing these due to the new CCI rules that started this year not allowing 59 modifier to be added to a shoulder code that is bundled into another procedure.

Any input is appreciated.

Thanks!

Kimberly Sampson, CPC
Insurance Coordinator

You won't get paid by any carrier for biceps tenotomy (29999). This was before the CCI edits. They bundle the tenotomy with any other procedure because it is a low work/time procedure. We are now reporting the tenotomy with the debridement codes 29822-29823 only if the doc documents a debridement of the stump/area after the tenotomy is performed.

 

[kdsampson]

We actually have been paid on these. Per instruction I had received at a Decision Health seminar, if biceps tenotomy is done during debridement it would be considered part of 29822/29823, but if Dr. does tenotomy without debridement it would appropriate to use 29999 to report the tenotomy.

We have received reimbursement for this procedure cause I had been following our claims for this, recently I've had denials from Medicare on this code. Just wanted to see if anyone else that had been billing these were also receiving denials from Medicare.

Thanks