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Orthopedic Coding Alert

Reader Questions:

Appeal When Payers Don't Recognize -59

Question: I have difficulty collecting for arthroscopy of the glenohumeral joint (29822) when I also perform arthroscopic shoulder decompression (29826) at the same session. How can we collect for these procedures?

Tennessee Subscriber Answer: Because the National Correct Coding Initiative (NCCI) includes debridement (29822, Arthroscopy, shoulder, surgical; debridement, limited) as an edit with 29826 (... decompression of subacromial space with partial acromioplasty, with or without coracoacromial release), insurers won't reimburse you for both services unless you append modifier -59 (Distinct procedural service) to 29822. Because your surgeon performed a procedure in the glenohumeral joint in addition to a procedure in the subacromial space, you are justified in appending modifier -59 to separate the NCCI edit.
 
Some payers, however, do not recognize modifier -59. If your insurer falls into this group, you should appeal the denial with a short letter describing the procedure, noting the fact that you addressed two separate areas, along with a copy of your operative report.


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