Orthopedic Coding Alert

Arthroscopic SAD Edits Vary According to Source


- Published on Sun, Nov 14, 2004

Compare AAOS' code pairs with NCCI's before you bill 29826

Orthopedic coders know that you can't always follow just one source when it comes to component codes. Although the National Correct Coding Initiative (NCCI) dictates which codes you can and can't bill to Medicare with your main procedure, private payers often use their own rules - and don't always go by the NCCI.
 
The American Academy of Orthopaedic Surgeons (AAOS) publishes its Complete Global Service Data for Orthopaedic Surgery, which explains which procedures the AAOS believes are components of one another - and these don't always match the NCCI's policies.
 
The following list will help you determine which codes the NCCI bundles into 29826 (Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or without coracoacromial release).
 
Note that you can bill procedures that feature an asterisk (*) with 29826 if you append a modifier (such as
-59, Distinct procedural service) to denote that the surgeon's operative report demonstrates that he went above and beyond the normal service included with shoulder surgery code 29826.
 
NCCI bundles the following codes into 29826:
 

  • 23700* -  Manipulation under anesthesia, shoulder joint, including application of fixation apparatus (dislocation excluded)
     
  • 29805* - Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure)
     
  • 29820* - Arthroscopy, shoulder, surgical; synovectomy, partial
     
  • 29822* - ... debridement, limited
     
  • 29825* - ... with lysis and resection of adhesions, with or without manipulation.

    The AAOS does not include 29822 in the global service package for 29826. Most coding consultants agree, however, that if the surgeon merely performs limited debridement in the subacromial space, as may be the case with rotator cuff procedures, you should not report 29822 in addition to 29826.
     
    Both CPT guidelines and the AAOS state that SAD (29826) inherently includes suture removal, wound irrigation, pain pump and surgical drain insertion, wound closure and repair, and dressing, splint or cast application services.



  • Orthopedic Coding Alert
    Issue - Nov, 2004
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