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Arthroscopic to Open Shoulder Surgery

Nicole Posted Tue 08th of September, 2015 18:24:16 PM

The doc did the following:
Arthroscopic decompression- 29826
Arthroscopic debridement subscapularis and bicep tendon- 29822

Once those procedures were done the doc then converted the rest of the remaining procedures to open:

Open repair subscapularis
Open repair supraspinatus and intraspinatus tendons
Open bicep tenodesis- 23430
Open bicep tenolysis

Would the rest of the open pprocedurs fall under the cpt code 23410? I am billing for an ASC.

SuperCoder Answered Wed 09th of September, 2015 00:45:13 AM

NCCI edits states "CMS considers the shoulder joint to be a single anatomic structure. An NCCI procedure to procedure edit code pair consisting of two codes describing two shoulder joint procedures should never be bypassed with an NCCI-associated modifier when performed on the ipsilateral shoulder joint. This type of edit may be bypassed only if the two procedures are performed on contralateral joints." Irrespective of arthroscopic or open procedure or both or arthroscopic converted to open, you can only bill for 23410 (Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute), as subscapularis, supraspinatus and intraspinatus muscles are of rotator cuff muscles, CPT 23430 for open biceps long tendon tenodesis. You cannot bill 29822 and 29826 in any circumstances, if done on same shoulder.

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