Wiki Shoulder Surgeries

[latishakautz]

We have been going back and forth with insurance about our shoulder surgeries. CPT codes are 29827, 29826, 29824, 23430. We have tried several scenarios and haven't been able to get all codes paid. Are most recent discovery was Department of Labor required NO modifiers and paid all codes, but that doesn't fly with the other insurance companies. From what we can tell 29827 would be the main CPT. 29826 is an add-on code and requires no modifier if used in conjunction with 29827. 29824 we have given both a -59 and -51 modifier (with no luck getting paid) and 23430 a -59 modifier. Even with one that was billed everything was paid except for the 29827 but to our understanding it wouldn't require any modifiers.

Has anyone had to bill or had any luck with billing these? Even with Medicare we have used XU on the 29824 and 23430 i believe and still cant find a good solution. If honestly seems like every insurance has a different rule when it comes to it. Thanks you the help in advance!!!!!

 

[Aleida]

Cpc

Remember to always submit anatomical (laterality) modifiers (RT, LT, 50).

 

[Orthocoderpgu]

None of these codes hit an NCCI edit

I'm scratching my head as to why you are having problems. None of these codes hit an NCCI edit, so modifier -59 should not be necessary.

 

[latishakautz]

Obviously we are applying the RT, LT, and 50...........

We thought the same for the -59 but then we are still getting some denials when its not used....