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Arthroscopic to Open Shoulder Surgery

Karen Posted Wed 30th of September, 2015 09:59:01 AM

I have a question about a previous post by a different user, if we check CCI edits at Supercoder website and use these three codes, 29826, 29822 & 23430 it doens't show that there are any CCI edits, wouldn't an edit have showed up?

User id : 13296Posted 3 weeks ago

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.

SuperCoderPosted 3 weeks ago

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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SuperCoder Answered Thu 01st of October, 2015 03:25:14 AM

Well, it does not mean that if bundling is not there then performed procedure can be billed together. Due to this misconception, we land up with denials. CPT 29826, 29822 & 23430 will not show CCI bundling, for this it is required to know the procedure specific guidelines which says- if any arthroscopic procedure for the same anatomical location turned into open procedure due to any reason, then only open procedure has to be billed. Whereas, 23410 is highest RVU value procedure amongst the mentioned CPT codes, so it is advisable to bill for higher RVU value procedure instead of lower RVU value procedure to avoid the loss in dollar value. Hope it clear your doubt.

Karen Posted Thu 01st of October, 2015 10:48:24 AM

Thanks for your help!

SuperCoder Answered Sat 03rd of October, 2015 14:26:31 PM

You are welcome!

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