“Subacromial Decompression.

Mrs. Smith had an arthroscopic shoulder procedure at ABC Hospital in Outpatient Surgery on 05/07/2022. Dr. Greene did the surgery, and he documented “Subacromial Decompression. The Coder reviewed the documentation and assigned CPT 29826. The claim was processed and returned with a remark code of N122 attributed to the CPT on this claim. As a coding consultant, you have been tasked to conduct audits on Orthopedic encounters, with 29826 attributed to them. During auditing claims, you find a trend related to the CPT coding of 29826. You will need to present responses to the below prompts and provide detailed explanations. The explanations should be compiled as if you were providing results to the coding leadership and educating the coding staff about your findings. As the coding consultant, you will also need to provide a solution for the billing staff related to the EHR system and determine what solution should be implemented to avoid remark code N122 on claims when 29826 is coded. 

1. Explain what the Remittance Advice Remark Code N122 signifies and why it applies to CPT 29826 coded in this case.

2. Demonstrate the appropriate use of code assignment 29826 for orthopedic procedures.

3. Differentiate the steps needed to correct the claim by the provider, coder, and billers.

4. Recommend Training solutions for providers and coders.

5. Recommend System/Billing solutions for the organization.

6. What other steps or components should the Coding Manager consider to avoid this problem and monitor ongoing progress for the coding team?

7. How do cases like this, where the claim has already been sent out, affect the Revenue Cycle?  Be sure to include how certain areas of RCM are affected.