Do you frequently receive denials because of the intricate billing processes associated with add-on codes? You are not alone, so don’t worry. This is a problem that many billers encounter. However, we are here to assist you. By being aware of how CPT code 29826 is documented, other billing guidelines, and filing proper claims, you can prevent denials.
Fortunately, our comprehensive guide discusses everything about this code, from clinical scenarios to applicable modifiers and reimbursement guidelines. So let’s start!
CPT Code 29826 – Description
CPT code 29826 refers to a minor surgical shoulder arthroscopy for decompression of the subacromial space with partial acromioplasty and coracoacromial ligament.
In simple terms, the surgeon uses a small incision to examine the shoulder joint with an instrument known as an arthroscope. It is a thin tube with a light and a camera on one end. He inserts additional instruments via the keyhole incision and repairs the shoulder blade and coracoacromial ligament to alleviate irritation and pain from shoulder joint impingement.
The procedure also involves the removal of any bone spurs or other obstructions that may be pinching the rotator cuff or surrounding tissues, to relieve pressure and enhance shoulder function.
Scenarios Where CPT Code 29826 is Applicable
Look at the following scenarios to understand the accurate application of CPT code 29826.
Persistent Pain due to Shoulder Impingement
Suppose a 45-year-old office worker has been experiencing persistent shoulder pain for more than a year. Particularly when lifting an arm or reaching overhead. Painkillers and physical therapy were ineffective.
An orthopedic surgeon orders an MRI, which indicates narrowing beneath the acromion bone. For treatment, he shaves a tiny portion of the bone and performs arthroscopic subacromial decompression to remove inflammatory tissue. Hence, he can report CPT code 29826 along with the primary arthroscopic procedure code for his services.
Injury Causing Shoulder Impingement
Imagine another scenario of a 50-year-old construction worker who experiences progressive shoulder pain that makes it difficult for him to do everyday tasks. He visits the nearest orthopedist, who initially prescribed conservative treatment options, like painkillers and physical therapy. However, it did not improve his condition.
This time, the same physician orders his MRI, which shows signs of thickening of the subacromial bursa with modest acromial spurring. So, the orthopedist performs a minimally invasive shoulder surgery to reduce impingement, and arthroscopic subacromial decompression is used to smooth the acromion and eliminate inflammatory tissue. The orthopedist can bill his services with CPT code 29826 and the primary code.
Applicable Modifiers for CPT Code 29826
Many healthcare providers apply modifier 51 to CPT code 29826 to indicate multiple procedures during the same surgical session. However, 29826 is an add-on code. Therefore, modifiers are not applicable to this code. Add-on codes are always billed with their primary codes, and necessary modifiers are only applied to the primary code.
CPT Code 29826 – Billing & Reimbursement Guidelines
Do not miss the following billing and reimbursement guidelines for CPT code 29826.
Ensure Correct Application of 29826
Since 29826 is an add-on code, it must always be billed with the appropriate primary code. Typically, it is used with these primary codes (29827, 29828, and 29806-29825). In contrast, your claim will be denied if you bill this code as a stand-alone because payers want to know which primary shoulder arthroscopy treatments were performed on the same day.
Maintain Accurate Documentation
Your paperwork plays a significant role in demonstrating the medical necessity of the procedure. It should include detailed records of the patient’s health, proof of unsuccessful conservative treatments (physical therapy and NSAIDs), and the specifics of the procedure. Maintenance of proper documents is an essential requirement set by the majority of payers, including Medicare. So, to secure reimbursement for CPT code 29826, you must not miss the following details in your paperwork.
- Proof of shoulder impingement syndrome.
- Evidence of failed conservative treatment.
- A note of structural findings requiring decompression.
- Mention of correct ICD-10 codes.
- Operative notes detailing acromial reshaping or bone resection were performed.
- Proof that medical necessity for this is separate from the primary procedure’s need.
- Other important details about the patient and the provider.
Furthermore, the operative note is the key document that must clearly document:
- Evaluation of the subacromial space.
- Removal of the inflamed bursa (bursectomy).
- Acromioplasty or reshaping of the acromion.
- Surgical technique used arthroscopically.
- Statement that the decompression was medically necessary.
Understand the Global Period Rules
According to the status indicator, the global period for CPT code 29826 will be determined by the principal service. Its primary procedures include a surgical procedure of the shoulder. Hence, the global period for shoulder surgery is 90 days. Medicare, however, categorizes it as a ZZZ code, indicating that the principal procedure determines its global timeframe.
Final Word
We will now wrap up our explanation of CPT code 29826. We hope that by now you are aware of all the crucial information needed to bill this code. Nonetheless, let’s recap it! CPT 29826 represents arthroscopic subacromial decompression of the shoulder with partial acromioplasty. Since it is an add-on code, you cannot apply a modifier to it. Moreover, it must always be reported with its primary procedure code.
We recommend acquiring MediBillMD’s expert orthopedic billing services if you are still unclear about the code’s billing or are receiving denials for your claims. Their team of skilled medical billers has maintained a 97% first-time claim acceptance rate, allowing you to collect reimbursements on time.
