Medical Billing Forum
Coding => Coding => : RMHN October 18, 2010, 01:08:59 PM
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I need help when billing 29805-Shoulder arthroscopy. Our surgeon also wants to bill 23130 and 23120. What modifier can be used to get all three procedures paid? This is for a medicare patient. Thanks!
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Modifiers cannot be used strictly to get a claim paid. They must be warranted by the services performed. The only way you can tell if they would be warranted is by either getting them from the provider or a coder looking at the patient's surgical notes.
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I have read the reports and it does appear the additional codes should be considered. The patient actually has medicaid, not medicare and i was under the impression Medicaid does not accept modifier 59. (wyoming medicaid)
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I'm not familiar with Wyoming medicaid. The states I have billed do accept the 59 modifier but the 51 modifier may be more appropriate for what you have described.
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Is this a subacromial decompression? Because depending on how the chart reads the 29805 could be included in the 23130 and not able to be billed with a modifier if a repair was done.