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Blackhorse Posted Fri 05th of January, 2018 19:17:44 PM
PREOPERATIVE DIAGNOSES: 1. Large right rotator cuff tear. 2. Right shoulder subacromial impingement syndrome. POSTOPERATIVE DIAGNOSES: 1. Massive right rotator cuff tear involving the entire infraspinatus and supraspinatus with delamination and significant retraction. 2. Biceps tendon sheath instability with biceps tendon subluxability. 3. Right shoulder subacromial impingement syndrome. 4. Extensive intraarticular synovitis of the anterior, superior and posterior capsular compartments. 5. Extensive subacromial and subdeltoid bursal hypertrophy. PROCEDURES PERFORMED: 1. Right shoulder arthroscopy with arthroscopic repair of massive right rotator cuff tear-added difficulty due to the size of tear and delamination. 2. Right arthroscopic biceps tenodesis. 3. Right arthros cop ic subacromial decompression. 4. Arthroscopio subacromial and subdeltoid extensive burs al debridement and intraarticular extensive synovectomy. We billed 29827-22-RT (S43.421A), 29828-RT (M75.21), 29823-59-RT (M75.21), 29826-RT (M75.41). Anthem denied 29827, The reason on EOB is "charge exceed allowed amount". We called them a couple times and nobody can explain clearly why. Do you know why?
SuperCoder Answered Mon 08th of January, 2018 06:48:59 AM

Hi,

All the CPT codes are separately reimbursible and there cannot be a reason found for denial of Cpt code 29827. The insurance only is needed to be contacted for the reason of denial.

Blackhorse Posted Mon 08th of January, 2018 12:30:05 PM
Anthem rep tells me that 29827 is bundled with other codes. Is that true?
SuperCoder Answered Wed 10th of January, 2018 08:19:32 AM

Hi,

The only possible CCI edits according to Cms.gov are :

Shoulder arthroscopy procedures include limited debridement (e.g., CPT code 29822) even if the limited debridement is performed in a different area of the same shoulder than the other procedure. With three exceptions, shoulder arthroscopy procedures include extensive debridement (e.g., CPT code 29823) even if the extensive debridement is performed in a different area of the same shoulder than the other procedure. CPT codes 29824 (arthroscopic claviculectomy including distal articular surface), 29827 (arthroscopic rotator cuff repair), and 29828 (biceps tenodesis) may be reported separately with CPT code 29823 if the extensive debridement is performed in a different area of the same shoulder.

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