1. User id : 33255 Posted 1 year ago #
   

   My physician was told by another orthopaedic surgeon that he codes out a synovectomy (27054) and/or capsulectomy (27036) with a total hip arthroplasty (27130). These two are bundled with the THA but can be unbundled (NCCI). Under what circumstances would a mod 59 be allowed on 27036 and/or 27054 to charge them out with a THA (27130)?

2. User id : 21400 Posted 1 year ago #
   

   Yes, As per NCCI edit we may use 27054-59 and 27036-59 along with 27130.
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   If there is separate medical necessity, then it is ok to report these codes together.
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   27036 - Capsulotomy includes several of the different anatomical area including fascia and muscle; however the code 27130 includes bone and joint.
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   As per my experience, the insurance carrier use to pay 27130 and 27036-59 however deny the code 27054-59 (even with modifier 59) based upon the anatomical consideration.
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   It is appropriate to use 27054-59 and 27036-59 along with 27130 subject to if medical necessity allow.

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