Wiki SCR procedure coding

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Cwirtalla

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How are your reporting a SCR procedure?
We are having a difficult time getting codes 29827 and 29806 authorized without a peer to peer. I am afraid when we bill the 29827 and 29806-59 they will be denied.
Has anyone had any luck with these two codes being paid together. Is anyone else coding this procedure differently?

Thank you in advance for any advice or input!
 
Cwirtalla said:
How are your reporting a SCR procedure?
We are having a difficult time getting codes 29827 and 29806 authorized without a peer to peer. I am afraid when we bill the 29827 and 29806-59 they will be denied.
Has anyone had any luck with these two codes being paid together. Is anyone else coding this procedure differently?

Thank you in advance for any advice or input!
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If the provider is performing arthroscopic SCR neither of these codes would be reported.
 
Arthscopic superior capsule reconstruction should be reported as an unlisted procedure.
AMA advised 29999. This was also the last information I knew of from AAOS.


How do I code for a superior capsular reconstruction?

There is no code for superior capsular reconstruction. The best option is to code for other procedures that are done concomitantly and documented in the surgical report. For example, if a rotator cuff repair was done, even a partial repair, then code 29827 is used. If the criteria for debridement is met, then 29823 should be coded (see criteria below). Additionally, a modifier 22 may be added to other codes that are used if felt to be appropriate and supported by the surgical documentation.

If no other procedures are done or documented, the final option would be to code 29999 and reference a similar code in terms of work such as 29827 (preferable) or 29806.

How to bill and report for Arthroscopic Superior Capsular Reconstruction This is a reminder if your surgeon is doing ASCR for irreparable rotator cuff tear, CPT April 2017 Assistant clearly states it should be reported using the unlisted 29999. It would not be appropriate to report the capsular repair code 29806 as they are treating rotator cuff issues. By using the unlisted code, it will help to show tracking and the need for a new code.
 
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