CPT code 29806 is a medical billing code for shoulder arthroscopy surgery involving capsulorrhaphy, a procedure to repair shoulder instability.
CPT code 29806 is a procedure code that refers to a surgical intervention involving the shoulder joint. Specifically, it denotes a capsulorraphy, which is a surgical repair of the joint capsule. This procedure is typically performed to stabilize the shoulder, often in cases of dislocation or instability, by tightening or reinforcing the capsule surrounding the joint.
When billing for CPT code 29806, which pertains to shoulder arthroscopy with capsulorrhaphy, several modifiers may be applicable depending on the specific circumstances of the procedure. Here is a list of potential modifiers that could be used:
1. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both shoulders during the same session.
2. Modifier 51 - Multiple Procedures: This modifier is applicable if multiple surgical procedures are performed during the same operative session.
3. Modifier 59 - Distinct Procedural Service: This modifier should be used when the procedure is distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: Use this modifier 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: This modifier is appropriate 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 is applicable if a different procedure is performed by the same physician during the postoperative period of the original procedure.
8. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services: This modifier can be used when the procedure is performed by a non-physician provider under the supervision of a physician.
9. Modifier LT - Left Side: Use this modifier if the procedure is performed on the left shoulder.
10. Modifier RT - Right Side: Use this modifier if the procedure is performed on the right shoulder.
Each of these modifiers serves to provide additional context to the procedure being billed, ensuring accurate reimbursement and compliance with payer requirements.
CPT code 29806 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides a comprehensive list of the payment rates for services covered by Medicare, including CPT code 29806. To determine the exact reimbursement rate for this code, healthcare providers should refer to the MPFS.
Additionally, Medicare Administrative Contractors (MACs) play a crucial role in the reimbursement process. MACs are responsible for processing Medicare claims and can provide region-specific information regarding the reimbursement of CPT code 29806. Providers should consult their respective MAC for detailed guidance on billing and reimbursement for this code.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level and by individual payer. With RevFind, you can identify discrepancies for specific services, such as CPT code 29806, ensuring you receive the full reimbursement you deserve. Schedule a demo today to see how RevFind can optimize your revenue recovery process.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
