CPT code 29825 is a medical billing code for shoulder arthroscopy surgery, including labral repair and joint stabilization procedures.
CPT code 29825 is a surgical procedure code that refers to the arthroscopic surgery of the shoulder. Specifically, it involves the repair of a labral tear, which is an injury to the cartilage that surrounds the shoulder joint. This procedure may also include the removal of loose bodies or debris within the joint, enhancing the overall function and stability of the shoulder.
When billing for CPT code 29825, 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 is applicable when multiple procedures are performed during the same session.
3. Modifier 59 - Distinct Procedural Service: Use this modifier to indicate that a procedure is distinct or independent from other services performed on the same day.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when the same procedure is repeated by the same physician on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier indicates that the same procedure was performed by a different physician on the same day.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room: Use this modifier if a patient returns to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is applicable if a procedure is performed that is unrelated to the original procedure during the postoperative period.
8. Modifier 22 - Increased Procedural Services: Use this modifier if the procedure required significantly more work than typically required.
9. Modifier 24 - Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: This modifier is used when an evaluation and management service is provided that is unrelated to the procedure during the postoperative period.
10. Modifier 27 - Multiple Outpatient Hospital E/M Encounters on the Same Date: This modifier is applicable when multiple evaluation and management services are provided on the same day in an outpatient setting.
Each of these modifiers serves a specific purpose and should be used in accordance with the guidelines set forth by the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) to ensure accurate billing and reimbursement.
CPT code 29825 is reimbursed by Medicare, but the reimbursement specifics can vary based on several factors. The Medicare Physician Fee Schedule (MPFS) provides the payment rates for services covered by Medicare, including CPT code 29825. However, the actual reimbursement amount can differ depending on the geographic location and the policies of the Medicare Administrative Contractor (MAC) that processes claims in your region. It is essential to consult the MPFS and your local MAC for the most accurate and up-to-date reimbursement information for CPT code 29825.
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. For instance, with CPT code 29825, you can ensure that every dollar is accounted for. Schedule a demo today to see how RevFind can help you identify and recover underpayments effectively.
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
