Wiki Medicare BCBS HMO denying cpt codes 29823 and 29824 with 29827 and 24340

shortee3810

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Is anyone having trouble with Medicare BCBS HMO with them denying cpt codes 29823 and 29824? They are saying it is incidental to primary code 29827. It is not incidental to primary code because MD debrided 3 or more structures in different areas of shoulder and also did a distal shoulder claviculectomy (24340). Do anyone give any feedback on this?
 
Question - You have listed 24340, that is a biceps tenodesis at the elbow (separate procedure). Is that what you meant to type? 29824 is a DCR via scope. Or did you mean an open biceps tenodesis at the shoulder (23430?)

29827, 29824, & 29823 don't have NCCI edits. However, I would be curious to see the op note (redacted). Was it really three discrete structures not related to the 29824 & 29827, (doubtful)? Was there a SAD or anything else done?

They may still be looking for an X or 59 modifier due to the NCCI manual (not the P2P edits). But it has to be supported by the documentation. They could be following Anthem edits, did you check Availity and Clear Claim Connection?

7. Shoulder arthroscopy procedures include limited debridement (e.g., CPT code 29822) even if the limited debridement is performed in a different area of the same shoulder than the other procedure. With 3 exceptions, shoulder arthroscopy procedures include extensive debridement (e.g., CPT code 29823) even if the extensive debridement is performed in a different area of the same shoulder than the other procedure. CPT codes 29824 (Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure)), 29827 (Arthroscopy, shoulder, surgical; with rotator cuff repair), and 29828 (Arthroscopy, shoulder, surgical; biceps tenodesis) may be reported separately with CPT code 29823 if the extensive debridement is performed in a different area of the same shoulder.
 
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