Thank you, that is most helpful!Under NCCI rules, 29819 is considered a component of the other three shoulder arthroscopy codes you've billed. Although NCCI states that this can be bypassed with a modifier, the use of modifier 59 must be supported in documentation showing, for example, that this procedure was performed at a separate anatomical site or through a separate incision. Without seeing your physician's note, it's hard to say whether or not the modifier is appropriate, but since your LT modifier indicates that these procedures were all done on the same shoulder, I think it would be very unusual to see 29819 done as a separate procedure on the same shoulder and not as an incidental part of the other laparoscopic procedures.
In 2017 CMS updated the CMS NCCI Surgical Policy Manual to state that anatomically the shoulder is considered one anatomical location. Due to this decision you can no longer use the -59 modifier on shoulder surgeries. If it hits an edit, it can't be billed. W/C follows CMS. This information can be found in past issues of the HBM.We had a WC claim come back stating 29819-59-LT value for procedure was included in the value of the comprehensive procedure along w/the documentation with the claim not supporting this code for reimbursement. The other codes billed out were 29824-LT, 29823-LT, & 29826-LT. Has anyone had trouble not getting payment for 29819, using modifier 59, when billed w/the other codes that were on the claim. Thanks for the help!
Pam C