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1. Arthroscopic shoulder debridement (29822) is often bundled incorrectly. There are times when it is appropriate to unbundle 29822 with other shoulder procedures. For example, an arthroscopic rotator cuff repair is performed in addition to a subacromial decompression and the debridement of a labral tear. The labral tear is unrelated to the rotator cuff and the subacromial decompression and therefore should be reported with modifier -59.
2. Syndesmosis repair (27829) should be reported with an open treatment of lateral malleolus, 27792 if a separate incision is made.
3. 49568, implantation of mesh, is often not reported when it should be with incisional and ventral hernia codes 49560-49566. If mesh is used with these types of open hernia repairs, the 49568 should be reported as an add-on code. It is also misused and reported with other types of hernia repairs.
4. Hardware removal (20680) is reported once per original injury site or fracture. 20680 should only be reported multiple times if hardware is being removed from multiple injury sites or fractures. It should not be reported multiple times for removal of each screw or plate from the same injury site regardless of the number of incisions.
5. Abrasion arthroplasty or microfracture of the knee (29879) is reported per compartment of the knee. For example, if the procedure is being done is both the medial and lateral compartments you would report 29879 twice and append modifier -59 to the second one. Also, it is important that the documentation supports debridement down to bleeding bone or drilling of holes.
6. When synovectomy is performed in medial, lateral and patellofemoral compartments in conjunction with medial and lateral meniscectomies, the synovectomy can only be reported for the compartments in which it is the only procedure being performed. In this situation, the extensive synovectomy (29876) becomes a partial (29875) since there is only one compartment in which the synovectomy is reportable. So in other words, for this scenario you would report 29880 for the medial and lateral meniscectomies and 29875 for the synovectomy in the patellofemoral compartment.
7. Percutaneous palmar fasciotomy for Dupuytren's (26040) should be reported only once per hand no matter how many digits are released. It would be appropriate to report as a bilateral procedure if performed on both hands.
8. Integumentary codes for excision of malignant lesions (11600-11646) or benign lesions (11400-11446) are not separately reportable with adjacent tissue transfer codes 14000-14302. Also, primary closure of the donor site is included in the flap codes, but if a separate flap or graft is performed to close the donor site, this can be coded as well.
9. Arthroscopic debridement of ACL tears should be reported with the unlisted code 29999. It would not be appropriate to report 29877 since this is for debridement of articular cartilage and the ACL is a ligament, not articular cartilage.
10. An incomplete colonoscopy is constituted as the inability to extend beyond the splenic flexure. ASCs are instructed to report incomplete colonoscopies with CPT 45378 and modifier -73 or -74, depending on with or without anesthesia.
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