Victoria Posted Mon 30th of March, 2020 11:47:14 AM
Our physician bills codes 29888 and 27427. Is it appropriate to bill 29888 with modifier 59 when he bills both?
SuperCoder Answered Tue 31st of March, 2020 09:17:07 AM
In the CPT code 29888, the provider makes small incisions in the knee area. He inserts the arthroscope through one of the incisions into the knee joint. He instills saline solution to inflate the area around the knee joint and improve her field of view. He identifies the tear in the anterior cruciate ligament. He inserts additional instruments and repairs the ligament by first harvesting tissue from a tendon in the knee. Alternatively, he uses donor graft and then applies the tissue graft, augmenting the anterior cruciate ligament and completing the repair. The provider then irrigates the area, checks for bleeding, removes any instruments, and closes the incision.
Whereas, in the CPT 27427, the provider makes an incision in the skin of the knee joint over the ligaments to be reconstructed. He dissects down through soft tissue to get access to the torn ligament. He then repairs the ligament by suturing the torn ends together and by attaching the ends to the bone using screws, staples, etc. Next, he may use a graft, which is a strip of tendon usually taken from a patellar tendon or hamstring muscle, to reinforce the stability of the ligament and for anchoring the ligament satisfactorily with the bone. Finally, he obtains hemostasis at the surgical site and closes the wound by suturing the soft tissue in layers. He may place a drain if required.
Since, there is most of the part of the procedure is over-lapping to each other, so but procedure 27427 is extra-articular, then as per CCI edits guidelines, both the codes can be billed together.
Since, code 29888 is a column 2 code for 27427, so use a CCI-associated modifier (59/XE/XP/XS/XU) to override the edit under appropriate circumstances with CPT 29888.
However, as per CCI Edits guidelines effective 01st July 2019- Associated Modifier can be appended with the Column 1 code also to override the edit under appropriate circumstances (applicable only for 59, XE, XP, XS, XU modifiers).
Hope this helps!