CERT Reviews for Arthroscopic Rotator Cuff Repairs

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October 4, 2018

Question:
We recently heard about Medicare doing CERT reviews for CPT code 29827 (arthroscopic rotator cuff repair).   We are not sure this is true and are wondering how we might find out more information?

Answer:
The information you heard is correct.  We cannot address Medicare’s Scope of CERT reviews but are aware this was addressed in a MLN Connects Article (June 28, 2018: Medicare Quarterly Volume Compliance Newsletter: Volume 8 Issue 1. (source: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/MedQtrlyComp-Newsletter-ICN909271.pdf).

The article summarizes the results as follows: “Most improper payments for HCPCS code 29827 in this special study were due to insufficient documentation errors. Insufficient documentation means something was missing from the medical records.”

KZA Recommended Action Steps:

  1. Ensure all office notes, radiologic reports, admission history and physicals, and other related documents are signed by the surgeon.
  2. Document a pre-operative and post-operative diagnosis.
  3. Include an Indication for Surgery paragraph in each operative note. This paragraph includes the nature of the condition (acute traumatic versus chronic condition), prior treatment if pertinent, failed conservative treatment for chronic conditions, and radiologic (e.g. MRI findings).
  4. Detail the procedure performed; avoid statements such as “and then the rotator cuff was repaired” without detailing the technique.
  5. Finalize operative notes and sign within 24 hours if possible. This allows the facility and the practice to submit charges in a timely fashion.

*This response is based on the best information available as of 10/04/18.

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