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Bundled Charges

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RMHN:
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!

Michele:
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. 

RMHN:
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)

Michele:
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.

oneround:
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.

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