Separately reportable arthroscopy

The patient came in for right shoulder multidirectional instability, and a right should examination under anesthesia, diagnostic arthroscopy and open arthrotomy with capsular shift stabilization of the right shoulder was performed. We entered the CPT codes of 29850 and 23466, but the NCCI edits say the codes are designated as separate procedures. If the procedure was carried out as an integral part of another procedure already coded then one should be deleted. These codes MAY be listed with modifier -59 if the separate procedure is independent of and not immediately related to the other procedures.

Further research said that a capsulorraphy of the glenohumeral joint for any tip multidirectional instability is done. The surgical approach may differ from patient to patient depending upon the patient’s history The incision is determined by the side of most significant instability. A separately reportable arthroscopic examination of the shoulder should be performed first to fully determine the extent of the damage to the joint and the appropriate surgical code. An anterior H-plasty is commonly used to tighten the capsule. In some cases, both medial and lateral capsular incisions may be required to provide sufficient capsular tension. ( 2008 Ingenix Procedures Desk Reference PG 157)


The question is do we add modifier 59 or not even report the diagnostic 29805? What would you suggest?

Listed codes

The codes you list are for knee (29850), code 23466 is a shoulder procedure. The CCI rules state, if a diagnostic scope (ex, 29805, shoulder) determined the necessity of a therapeutic open procedure (ex, 23466), code the diagnostic scope with modifier -58. Chapter 6, states, "In the case where the endoscopic procedure is performed as a diagnostic procedure upon which the decision to perform a more extensive [open] procedure is made, the endoscopic procedure may be separately reported, For Medicare payers, you should append modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) to the open procedure to indicate that the diagnostic endoscopy and the open surgical service are staged or planned.