Orthopedic Coding Alert

You Be the Coder: Check Your Modifiers for Shoulder Scopes


- Published on Wed, Sep 01, 2010

Question: An orthopedist in my practice arthroscopically repaired a rotator cuff on the left shoulder, and then aspirated the right shoulder. I used the LT and RT modifiers, of course, to indicate the doctor worked on different sites, but the insurer denied the claim anyway. How can I get reimbursement for the two separate procedures?

Vermont Subscriber

Answer: For these procedures, you can't stop with modifiers LT (Left side) and RT (Right side). You'll also need modifier 59 (Distinct procedural service). To report both the arthroscopy and aspiration, you should use 29827-LT (Arthroscopy, shoulder, surgical; with rotator cuff repair) and 20610-59-RT (Arthrocentesis, aspiration and/or injection; major joint or bursa [e.g., shoulder, hip, knee joint, subacromial bursa]).

Although the LT and RT modifiers indicate that your orthopedist treated different shoulders, modifier 59 definitively shows that the two procedures were separate in this case. Typically, 29827 includes the work associated with an aspiration. In this [...]

Orthopedic Coding Alert
Issue - Sep, 2010
Already a subscriber? LOGIN to read the article.