Forum - Questions & Answers

Jan 27th, 2012 - precod 10 

Modifier 51 in Shoulder CPT's

As per AAOS, Major changes occurred in the arthroscopy section of the 2012 CPT® Manual, reflecting Medicare’s 75 percent threshold of services being reported together.

With regard to shoulder arthroscopy, CPT® code 29826—“arthroscopic subacromial decompression”—is now an add-on code to CPT® codes 29806–29825, 29827, and 29828. Modifier 51 should not be used and 100 percent reimbursement should be expected.

In CPT®, a family is designated by a non-indented code followed by a group of indented codes. For example, codes 29819 through 29826 comprise one family of codes. Hence modifier 51 should not be used.

I have a doubt here the family of CPT® includes from 29819-29826 or 29806-29825,29827,29828.

Jan 31st, 2012 -

re: Modifier 51 in Shoulder CPT's

I'm in the process of coding an arthroscopic RCR, SAD, & DCE. Since 29826 is now an add-on code, it should be modifier 51 exempt. However I've got my 2012 CPT® book in front of me and it states on pg 145 (top right side of pg) "When arthroscopic subacromial decompression is performed at the same setting, use 29826 and append modifier 51". Am I missing something?



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