CPT code 29828 is a medical billing code for shoulder arthroscopy with biceps tendon repair surgery.
CPT code 29828 is a surgical procedure that involves the arthroscopic repair of a torn tendon in the shoulder, specifically focusing on the biceps tendon. This procedure is typically performed to alleviate pain and restore function by reattaching the tendon to the bone, using minimally invasive techniques.
When billing for CPT code 29828, which pertains to a specific surgical procedure, the following modifiers may be applicable:
1. Modifier 50 - Bilateral Procedure: Use this modifier if the procedure is performed on both sides of the body during the same session.
2. Modifier 51 - Multiple Procedures: This modifier is appropriate when multiple procedures are performed during the same surgical session, indicating that the primary procedure is being billed along with additional procedures.
3. Modifier 59 - Distinct Procedural Service: This modifier should be used when the procedure is performed separately and is not considered to be part of another procedure.
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 78 - Unplanned Return to the Operating/Procedure Room: Use this modifier if the patient requires a return to the operating room for a related procedure within the global period of the initial surgery.
6. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when a different procedure is performed by the same physician during the postoperative period of the initial surgery.
7. Modifier AS - Physician Assistant Services: This modifier indicates that a physician assistant performed the service, which may be relevant for billing purposes.
8. Modifier RT - Right Side: Use this modifier to specify that the procedure was performed on the right side of the body.
9. Modifier LT - Left Side: This modifier indicates that the procedure was performed on the left side of the body.
10. Modifier 22 - Increased Procedural Services: This modifier may be used if the procedure required significantly more work than typically required.
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.
CPT code 29828 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 29828. 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 for CPT code 29828. Providers should consult their respective MAC for detailed guidance on billing and reimbursement for this code to ensure compliance and accurate payment.
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 29828, 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
