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Billing a open procedure through the arthoscopic openings

Dempsey Posted Mon 20th of February, 2017 14:11:36 PM
My question is when a surgeon performs RC repair(298270, debridement (29823)and acromioplasty(29826), then uses one of the scope openings and opened it more to perform an open Bicep Tenodesis is the Tenodesis not billable because there has to be a separate opening to perform an open procedure when scope procedures were performed. Thank you, Ann Bitzer, CPC
SuperCoder Answered Tue 21st of February, 2017 02:16:35 AM

If open biceps tenodesis was performed through the arthrosicopic incision (by widen it and make it open), then you can bill CPT code 23430 "Tenodesis of long tendon of biceps". You can bill RC repair, debridement and acromioplasty with CPT code 23430.

Dempsey Posted Tue 21st of February, 2017 07:27:44 AM
So, if I have a bill that is doing scope procedures and then they use an existing opening (from the scope procedures) and extend it, it is payable? I was always told that if you are doing a scope and then you use one of the opening and extend it to perform an open procedure the open was not payable because there was not a separate incision.
SuperCoder Answered Wed 22nd of February, 2017 01:13:18 AM

As per NCCI edits "If an arthroscopic procedure is converted to an open procedure, only the open procedure may be reported. Neither a surgical arthroscopy nor a diagnostic arthroscopy code should be reported with the open procedure code when a surgical arthroscopic procedure is converted to an open procedure."

So, if arthroscopic procedure was converted into open, then only open procedure CPT code(s) should be reported. But here, the documentation provided indicates that RC repair, debridement and acromioplasty were done through arthroscopic approach and during the time of biceps tenodesis, it was decided to do it through open approach. So, all procedures were perform independently.

Also logically speaking, if provider is making arthroscopic incisions for ports and during conversion of arthroscopic to open procedure, they would prefer to extend the arthroscopic incision instead of creating a new incision for open procedures.

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