FOS Coding Corner

Coding Corner Sponsored by Karen Zupko & Associates, Inc.

These Frequently Asked Questions are provided to assist you with common orthopaedic coding issues. Check back monthly for updated topics.

This Month's Topic:
Medicare and Modifier 59

We are experiencing challenges when reporting an open rotator cuff repair (23412) with a subacromial decompression (29826). We are using modifier 51 on the second procedure and are constantly being denied. Can we report these two procedures together or are they considered bundled together?

It is correct coding to report both services assuming there is medical necessity for the surgeon for both services and the documentation supports both services.

The caveat here is that modifier 51 multiple procedure modifier will not allow the code combination to pass the edit. Append modifier 59 to CPT code 29826 when the documentation supports both procedures and medical necessity is documented.

Coding Corner Archive

Just click on a topic below to view the discussion:

Fracture Care (June 2009)
ACL and tendon grafts (April 2009)
26600 Reported with Three Units (November 2008)
Laminectomy with Microsurgical Technique (October 2008)
Navigation Assisted Procedures (February 2008)
Fractures (January 2008)
Instrumentation Removal and Reinsertion (July 2007)
Coding Existing Problem and New Problem on Same Visit (June 2007)
"CX-rays and "minimum views" (May 2007)
CPT Code Usage at the Beginning/End of a Year (January 2007)
Code for Core Decompression of the Hip (November 2006)
Hallux Valgus with a Chevron Metatarsal Osteotomy (August 2006)
Removal and Re-insertion of Spacer (May 2006)
Posterolateral Fusion L1-L5 (April 2006)
Modifier 62 (October 2005)
Coding Arthroscopic Elbow Surgery (July 2005)
Visit Included in Global Surgical Package or Not? (May 2005)
Cortizone injections (April 2005)
Athletic Trainers and Incident-To Physical Therapy (March 2005)
Coding for Range of Motion, 95851 (February 2005)
Conscious Sedation—Can I bill or not? Will the payors reimburse me? (January 2005)
New vs. Established Patient (December 2004)
Consults vs. IP Admission (November 2004)
Skeletal Traction Application Prior to Definitive Fracture Management (October 2004)
NPPS as Assistants at Surgery (September 2004)
Minimally Invasive Procedures (August 2004)
Modifier 51 versus 59 (July 2004)

Send an Issue or Question for Future Discussion

Email your orthopaedic coding issues and questions to fraser@fos-society.com