SHOULDER SCOPES CMS has revised the correct reporting of shoulder arthroscopies.

MODIFIER -59
New Shoulder Arthroscopy Reporting Rules

Don't append modifier -59 to an edit code pair describing 2 shoulder joint procedures — unless you perform the procedure considered the component of the primary procedure on the opposite shoulder, according to new shoulder reporting guidelines from CMS.

This doesn't mean that you can report only 1 shoulder code for all cases. The new guidelines state if there are bundling issues, modifier -59 wouldn't be appropriate unless it's to report the procedure performed on the contralateral shoulder. If there are no bundling issues, modifier -59 is not applicable and procedures are reported to Medicare as usual.

Let's look at an example. A surgeon performs CPT 29827 (arthroscopic rotator cuff repair), CPT 29824 (arthroscopic claviculectomy), CPT 29822 (arthroscopic limited debridement) and CPT add-on code +29826 (arthroscopy, shoulder, surgical; decompression of subacromial space). Only report 29827, 29824 and 29826 because CPT 29822 is bundled into 29827 and 29824 and CMS states not to append modifier -59 to CPT 29822 unless this debridement procedure was performed on the opposite shoulder. Let's say the same procedures indicated above are performed, except the arthroscopic debridement performed was unrelated to those procedures performed and reported with CPT 29827 and CPT 29824, of which 29822 reflects being a component. You wouldn't report and/or append modifier -59 to CPT 29822 unless this debridement procedure was performed on the opposite shoulder.

What happens to commercial reporting? You should verify individual commercial carrier reporting directives. While some commercial carriers follow CMS reporting policies, other commercial carriers may lean toward the American Medical Association and American Academy of Orthopaedic Surgeons reporting directives, which may differ from the CMS revision. Routine verification regarding reporting revisions is always the best practice.

Cristina Bentin, CCS-P, CPC-H, CMA
Coding Compliance Management
Baton Rouge, La.
[email protected]