CPT code 29805 is for a shoulder arthroscopy procedure that includes diagnosis and synovial biopsy.
CPT code 29805 is used to describe a surgical procedure involving the arthroscopy of the shoulder joint, specifically for diagnostic purposes and the collection of a synovial biopsy. This code indicates that the physician is performing a minimally invasive examination of the shoulder joint to assess any underlying conditions and to obtain a sample of the synovial tissue for further analysis.
When billing for CPT code 29805, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used with this code, along with the reasons for their use:
1. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both sides of the body.
2. Modifier 51 - Multiple Procedures: This modifier should be applied when multiple procedures are performed during the same session.
3. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that the procedure is distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the same procedure is performed more than once by the same physician on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician: Use this modifier if the same procedure is performed by a different physician on the same day.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room: This modifier is used if the patient requires a return to the operating room for a related procedure within the global period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier indicates that a procedure is unrelated to the original procedure performed during the postoperative period.
8. Modifier LT - Left Side: Use this modifier to specify that the procedure was performed on the left side of the body.
9. Modifier RT - Right Side: This modifier indicates that the procedure was performed on the right side of the body.
10. Modifier AS - Physician Assistant/ Nurse Practitioner/ Clinical Nurse Specialist Services: This modifier is used when the service is performed by a non-physician provider under the supervision of a physician.
It is essential to select the appropriate modifier(s) based on the specific circumstances of the procedure to ensure accurate billing and compliance with payer requirements.
The CPT code 29805 is reimbursed by Medicare, but it is essential to verify the specifics through the Medicare Physician Fee Schedule (MPFS) and your regional Medicare Administrative Contractor (MAC).
The MPFS provides detailed information on the reimbursement rates for various CPT codes, including 29805. Additionally, MACs may have specific guidelines or requirements that could affect reimbursement.
Therefore, it is advisable to consult both the MPFS and your local MAC to ensure accurate and up-to-date information regarding the reimbursement of CPT code 29805.
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