Wiki Scope to Open Shoulders

[Cassi3434]

HELP!! I've provided my physicians with the AAOS July 2017 AND Dec 2019 monthly articles in regards to coding shoulders. Specifically the guidelines for scope to open procedures and I'm getting some kickback. They want us to bill 23410, 29823-XS, and 29826 instead of my suggested 23410-22. They feel they are working in separate compartments and should be paid for these procedures. Is there any other policy/guidelines that you can direct me to in order to show my providers that when billing scope to open, we should only bill the open? I know CMS considers each shoulder 1 anatomical site and will not allow modifier 59 (which is why my providers have started using XS)…. sigh. Any help would be greatly appreciated!

 

[Orthocoderpgu]

This is an area where AAOS and CMS have had their arguments for several years literally. The president of AAOS has been meeting with CMS over this constantly. In 2017 CMS kind of gave in. They decided that yes to them the shoulder is one anatomical location and that any debridement that is not part of a restorative procedure could be billed separately as long as it was paired with 29824, 29827 or 29828. So with the codes you have listed 29823 could not be included since 29824, 29827 or 29828 is not being billed. That brings you to 29826 which also must be paired with 29XXX in the shoulder section which without 29823 you don't have, so that would not be allowed either. I hope AAOS keeps trying to educate CMS on this issue.