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Orthopedic Coding Alert

READER QUESTIONS:

Separate Compartments May Mean Extra Pay

Question: Our surgeon performed an arthroscopic Bankart procedure (29806) and a rotator cuff debridement (29822). NCCI bundles 29822 with the 29806 procedure, but it does allow appending modifier 59 to 29822 if warranted. Could we report 29806 with 29822-59 if the surgeon debrided a partial-thickness undersurface tear of the supraspinatus, or would this debridement not be considered above and beyond the normal requirements of the Bankart repair? We can't figure out what justifies use of modifier 59. Would you advise?


Connecticut Subscriber


Answer: For coding purposes, payers recognize two regions of the shoulder: the glenohumeral joint and the subacromial space. If your surgeon performed rotator cuff debridement in the subacromial space, you should append modifier 59 (Distinct procedural service) to 29822 (Arthroscopy, shoulder, surgical; debridement, limited). In this scenario, you can report 29822 separately because the surgeon performed the capsulorrhaphy on the glenohumeral joint.

You should only add 29822-59 to your claim for the Bankart (29806, Arthroscopy, shoulder, surgical; capsulorrhaphy) if the operative note documents that the surgeon performed the rotator cuff debridement from within the subacromial space.

As another example, you should report 29826 (Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or without coracoacromial release) and 29822-59 if the surgeon performs arthroscopic subacromial decompression and debridement of the labrum.

However, if the surgeon performs an arthroscopic rotator cuff debridement in the glenohumeral joint (as was the case with your first question), you should not append modifier 59 to separate the edit, because the surgeon performed both the debridement and the Bankart in the joint. Therefore, the National Correct Coding Initiative would be justified in bundling the procedures.


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