cpt code for shoulder arthroscopy with subacromial decompression
Biceps tenotomy (the removal of damaged tissue to promote healing) also meets the definition of debridement (29822 or 29823). Debridement is reported as either limited (29822) or extensive (29823). For example, a bursal-sided supraspinatus tear cannot be counted as a debrided structure if the supraspinatus is repaired in the same session.. For example, a bursal-sided supraspinatus tear cannot be counted as a debrided structure if the supraspinatus is repaired in the same session. Here are three examples of extensive debridement: The December 2016 CPT Assistant further clarifies that an extensive debridement additionally includes removal of osteochondral and/or chondral loose bodies, biceps tendon and rotator cuff debridement, and abrasion arthroplasty. For example, bone removal of less than 8 mm is a debridement, such as CPT 29822 or 29823 Arthroscopy, shoulder, surgical; debridement, extensive (see: AMA CPT Changes: An Insiders View 2002 and AAOS April 2004 Bulletin). Background: The rotator cuff is a frequent location of shoulder pain which can result in weakness and shoulder instability. However, before immediately abiding by these guidelines, theres one final point to consider. If all are normal we only bill the open RCR. Some examples of documentation to support medical necessity may include, but are not limited to: failed conservative treatments prior to the procedure, signed and dated diagnostic imaging reports, or preoperative surgeon notes. Was the service performed on the shoulder arthroscopically? To indicate procedures on different shoulders, you may use modifiers LT Left side and RT Right side. CPT 29827 is the only code for arthroscopic rotator cuff repair. 29821 Arthroscopy, shoulder, surgical; synovectomy, complete I know the debridement of the RC tear cannot be considered because it is the one being repaired but what about the greater tuberosity? Please reach out and we would do the investigation and remove the article. The AMA provided a clinical example when 29824 was first developed but it was strictly an example, and not all-inclusive of the requirements for reporting. A mini-open biceps tenodesis should be coded as open with 23430 Tenodesis of long tendon of biceps. For years, AAOS referenced size in their CodeX and Global Service Data books to be sure surgeons were not reporting 29824 for removing only a spur. Synovitis was present throughout. Why? Prior to biceps tenodesis, the surgeon often debrides and cuts the biceps (tenotomy). There is no CPT code to describe this procedure. You may want to double-check this with your contracted payers, also. For example, The patient had a labrum tear from 11 oclock to 2 oclock, with tacks/anchors/etc. The 7 mm does not meet the requirements of the claviculectomy. Operative Technique: After the satisfactory introduction of a general anesthetic, the patient was placed in the opposite lateral decubitus position, and his left arm was suspended from Bucks traction. Biceps tenodesis, or transferring the attachment of the biceps to the humerus (23430/29828), may be reported separately, according to CPT Assistant (July 2016), and is not part of a normal rotator cuff repair. She inserts additional instruments to repair a torn rotator cuff, the grouping of muscles and tendons that surround and support the shoulder joint. Under the National Correct Coding Initiative (NCCI) edits used by Medicare, Medicaid, some workers compensation payers, and some other commercial health payers, providers may never use an NCCI modifier, such as 59 Distinct procedural service, XE Separate encounter, XP Separate practitioner, XS Separate structure, or XU Unusual non-overlapping service to bypass the procedure-to-procedure edits in place for should surgery, unless the service is performed on the opposite shoulder. The four types of SLAP tears are: ** Type I-labral fraying with firmly attached labrum and biceps origin, ** Type II-labrum and biceps origin are detached from the labrum, ** Type III-bucket-handle labral tear with firmly attached labrum and biceps origin, ** Type IV-bucket-handle tear of superior labrum with extension into the biceps tendon with biceps displacement. Dr. Frederic A Matsen III and has not been proofread or intended for general However, before immediately abiding by these guidelines, theres one final point to consider. Before reporting 29823, be sure that the surgeon debrided three or more discrete structures and noted them in the record. Watch NCCI Edits on Debridements With Other Surgeries. Codes are: 29827, 29824, and 29823. Example: The surgeon performs arthroscopic debridements in the humeral bone and the humeral articular cartilage of a patients left shoulder. The AAOS Global Service Data Guide for Orthopaedic Surgery (GSD) states specifically that codes 29824, 29826, and 29827 are separately reportable. CPT code 29822 Arthroscopy, shoulder, surgical; debridement, limited includes debridement of soft or hard tissue. Ideally, the surgeon documents where on the labrum the work was performed; referencing clock positions is the best form of documentation. He is a member of the St. Paul, Minn., local chapter, and can be contacted at [email protected]. Encourage providers to describe the acromioplasty with morphology and the distal claviculectomy of approximately 1 cm separately, rather than to indicate the creation of a 1 cm space at the AC joint. Privacy Policy | Terms & Conditions | Contact Us. To appropriately assign the codes for this procedure, refer first to the term Arthroscopy in the index. Type III is either a debridement under 29822 or a SLAP repair under 29807 Arthroscopy, shoulder, surgical; repair of SLAP lesion. of shoulders, please visit Clinical coding guidelines: Shoulder arthroscopy ICD-10-AM/ACHI/ACS Eleventh Edition WA Clinical Coding Authority Purchasing and System Performance Division January 2020 Shoulder arthroscopy An arthroscope is a pen-shaped instrument with a very small video camera attached to the end. What is the Difference Between Dystonia and Dyskinesia? There are, however, three exceptions to the rule where its considered appropriate to code extensive debridement (29823) alongside the underlying arthroscopic procedure. In all other instances, you should not code extensive debridement with the primary arthroscopic procedure. If you havent stayed current, chances are you are under- or over-coding. 29827 (Arthroscopy, shoulder, surgical; with rotator cuff repair) The only difference is the modifier assigned. You will find that there is a CPT Assistant that states to report 23410/23412 with 29826; but then you will find an AAOS Bulletin that states to put a modifier 22 on the open code to take into consideration any additional work done via scope. Procedure Performed: Arthroscopy of the left shoulder with extensive debridement, subacromial decompression and resection of the AC joint. Check with your payer, however, as they may require a different code for the arthroscopic rotator cuff reconstruction (e.g., 29999 Unlisted procedure, arthroscopy). The American Medical Association (AMA) and the American Academy of Orthopaedic Surgeons (AAOS) agree that, to report 29821, the entire intra-articular synovium must be removed (CPT Assistant, June 2013, and AAOS Bulletin, April 2006). Fine debridement was done utilizing the full radius resector, once the bone was very soft. The first major revision is to code 29822, whose descriptor in 2021 is: (Arthroscopy, shoulder, surgical; debridement, limited, 1 or 2 discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, . Michael Strong, MSHCA, MBA, CPC, CEMC, is the bill review technical specialist at SFM Mutual Insurance Company. CPT 29826 requires both a subacromial decompression and a partial acromioplasty. Check payer policy (and get something in writing) before billing acromioplasty as a debridement code. NCCI states that you may only report 29823 with these codes if the extensive debridement is performed in a different area of the same shoulder. When reporting 29824, documentation should support that the entire distal end of the clavicle was resected. If the bur was used to reshape the acromion by removing osteophytes or excess bone, this could be a form of debridement. 2020 descriptor: (Arthroscopy, shoulder, surgical; debridement, extensive). Be sure there is clear documentation that bony work was performed on the acromion to support +29826. Interior contents of the shoulder were remarkable for some fraying of the anterior synovium in the shoulder and an area around the labrum. Example: A provider performs a subacromial decompression, biceps tenotomy, and debridement of the anterior labrum. Other times, CPT significantly revises a code and the effect is similar to getting an entirely new code. Type II and IV are coded 29807. Vaught is a member of the Olympia, Wash., local chapter. The first major revision is to code 29822, whose descriptor in 2021 is: (Arthroscopy, shoulder, surgical; debridement, limited, 1 or 2 discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body[ies])). Type I and Type III SLAP lesions with firmly attached labrum and biceps origin are coded as 29822 (arthroscopic debridement, limited). Wording now more specific, offers clearer guidance. The operative report should have a detaileddescription of the anchor or suture repair. For example, when performing a superior labral tear from anterior to posterior (SLAP) repair (29807 Arthroscopy, shoulder, surgical; repair of SLAP lesion) and a debridement of a rotator cuff tear and biceps tear (29823), you cannot separately report 29823, per NCCI guidelines, because the debridement is considered inclusive (unless its for the opposite shoulder; see NCCI guidelines, chapter 4). Resources: Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: a 5-year follow-up of a randomised, placebo surgery controlled clinical trial. Its inappropriate to report ASCR using 29827 (either with or without modifier 22). As a contributor you will produce quality content for the business of healthcare, taking the Knowledge Center forward with your knowhow and expertise. Given these differences, coding arthroscopic shoulder surgery for providers who follow AAOS guidelines can be challenging. Now, the line is much clearer. The first major revision is to code 29822, whose descriptor in 2021 is: (Arthroscopy, shoulder, surgical; debridement, limited, 1 or 2 discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body[ies])). Type I is always 29822, which is a debridement. A subacromial decompression is performed, with 1 cm removed from the distal clavicle. In this situation, coding 29827 (arthroscopic rotator cuff repair) with 29819-59 is allowed. NCCI lists the following codes as the three exceptions to when you may bill an arthroscopic debridement procedure in addition to an underlying arthroscopic surgery: This is inclusive to the tenodesis, so do not report it separately. Now, coders can count the structures and make a more informed decision because the codes address specifically what constitutes 29823 service. Sometimes, CPT drops a completely new code and coders need to get used to working it into their arsenal of choices. Many commercial carriers have also adopted NCCI, sometimes with modifications to reflect payer-specific medical policies and reimbursement methodologies. 2020 descriptor: (Arthroscopy, shoulder, surgical; debridement, limited) This is not a side to side or reattachment of the cuff tissue; it involves placement of graft material, which makes it a reconstruction, not a repair. To make sure you recoup proper reimbursement, lets address CPT codes 29821, 29822, 29823, 29824, 29826, 29827, 29828, 29806, and 29807, as well as arthroscopic superior capsular reconstruction (ASCR). Check out what all the hoopla surrounding this code pair is about with the following primer. CPT codes 29824 (Arthroscopic claviculectomy including distal articular surface), 29827 (Arthroscopic rotator cuff repair), and 29828 (Biceps tenodesis) may be reported separately with CPT code 29823 if the extensive debridement is performed in a different area of the same shoulder. 29822 debridement, limited 29824 (Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure)) Neither CPT nor the Centers for Medicare & Medicaid Services (CMS) state how much bone must be removed to be considered the entire distal end. If you are looking for medical information about the treatment Shoulder arthroscopy procedures include limited debridement (e.g., CPT code 29822) even if the limited debridement is performed in a different area of the same shoulder than the other procedure. In comparison, limited debridement involves only a couple of sites. Resources Codes 29824 and 29826 When reporting 29824, documentation should support that the entire distal end of the clavicle was resected. This remains the case despite the fact that the limited debridement may be performed in a separate area of the same shoulder. AAOS April 2004 Bulletin. compilation for random notes and resources. AAOS recognizes the glenohumeral joint, the acromioclavicular (AC) joint, and the subacromial bursa as separate anatomic areas. Prior to biceps tenodesis, the surgeon often debrides and cuts the biceps (tenotomy). ASCR is a newer arthroscopic procedure for an irreparable rotator cuff. Sometimes, CPT drops a completely new code and coders need to get used to working it into their arsenal of choices. The patient was then awakened from this anesthetic and allowed to return to the recovery area. on Stay Current when Reporting Shoulder Procedures, Stay Current when Reporting Shoulder Procedures, Tech & Innovation in Healthcare eNewsletter, www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Downloads/2017-NCCI-Policy-Manual.zip, Don't Choose Shoulder Scope Codes Off the Cuff, Update Your Understanding of Shoulder Arthroscopy Codes, Surgery Arthroscopy Includes Debridement (with an Important Exception), Combat Common Denials in Orthopedics Coding, A chondroplasty and a debridement of the labrum (a combination of hard and soft structures), An abrasion arthroplasty (microfracturing/drilling down to bleeding bone) and a biceps tenotomy (a combination of hard and soft structures) (see, Debridement of a biceps tendon and a partial thickness rotator cuff tear (multiple soft structures). To make sure you recoup proper reimbursement, let's address CPT codes 29821, 29822, 29823, 29824, 29826, 29827, 29828, 29806, and 29807, as well as arthroscopic superior capsular reconstruction (ASCR) Some payers have placed size references in their own internal policies, but that is a payer-contracted issue. Check with private payers, as well as workers compensation carriers, to see if they allow either 29806 or 29807 on the same shoulder. Subacromial decompression is usually done as a keyhole procedure. shoulder; glenohumeral and AC joint arthritis, severe. Thank you for this Mr. Strong. An orthopedic surgeon billed for HCPCS code 29827 and submitted the following: Signed operative report Signed pre-operative History and Physical for medical clearance prior to surgeryAn additional request for documentation returned no documentation. Information was intended for internal use only and is a Regarding 29823 There is an April 2006 AAOS Bulletin that states Code 29823 should be used only for extensive debridement of soft or hard tissue. In this case he also does a manipulation. Returning to the AC joint: Was the creation of the 1 cm space in the AC joint due to a distal claviculectomy, acromioplasty, or both? What to code when only an Acromioplasty is performed alone (29826) 29826 is defined as an Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (List separately in addition to code for primary procedure). These changes are valid only for the extensive debridement code. Patients your orthopedist treat for certain spinal [], Use Knowledge of Condition to Get Osteolysis Dx Right the First Time, Question: Encounter notes indicate that the orthopedist performed a magnetic resonance imaging (MRI) on a [], Question: Encounter notes indicate that the provider performed closed treatment of a fracture of a [], Follow Specific Rules for Cast Removal Coding, Question: When our provider removes a cast from a patient boot, body, full arm/leg, [], Question: Our provider recently documented a patient as having both type 1 and type 2 [], Question: Our surgeon examined a patient in the office and sent a report about the [], Copyright 2023. If acromioplasty is not performed, report only a debridement. 29826 - subacromial decompression 2012 Arthroscopic Shoulder Coding Changes 29826 + (Addon) Arthroscopy, shoulder, surgical, decompression of subacromial space with partial acromioplasty with coracoacromial ligament (arch) release, when performed (list separately in The second revision is to code 29823, whose descriptor in 2021 is: (Arthroscopy, shoulder, surgical; debridement, extensive, 3 or more discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body[ies])). The second revision is to code 29823, whose descriptor in 2021 is: (Arthroscopy, shoulder, surgical; debridement, extensive, 3 or more discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body[ies])). The AAOS, the Arthroscopy Association of North America, and the AMA advise to report this scenario with an arthroscopic debridement code, 29822 (soft tissue only) or 29823 (bone and soft tissue). With few exceptions, NCCI edits bundle arthroscopic debridement into all arthroscopic surgical codes for the joint being worked on. The description of the procedure by the surgeon includes extensive debridement of the joint due to the marked glenohumeral erosion and synovitis. 2020 descriptor: (Arthroscopy, shoulder, surgical; debridement, extensive) Only one rotator cuff repair code is allowed, per shoulder. As of July 1, 2016, (and as further clarified in the updated National Correct Coding Initiative (NCCI) guidelines effective Jan. 1, 2017), 29823 may be reported separately with 29827 Arthroscopy, shoulder, surgical; with rotator cuff repair, 29828 Arthroscopy, shoulder, surgical; biceps tenodesis, and 29824 Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure). The humeral head was perfect, as was the socket, and there were no Hill-Sachs or Bankart lesions. All the articles are getting from various resources. placed at 11, 1, and 2 oclock. This documentation indicates the surgeon worked on the upper half of the labrum code, and supports 29807. Whether one or all four components that make up the rotator cuff (supraspinatus, infraspinatus, teres minor, and subscapularis (SITS)) are repaired in a single shoulder, report a single unit of 29827. He is a former senior fraud investigator with years of experience performing investigations into fraud and abuse. If the 3 mm removed from the acromion is a true acromioplasty achieved by converting the acromion to a type I morphology with a subacromial decompression proper coding is 29822 and 29826. Most improper payments for HCPCS code 29827 in this special study were due to insufficient documentation errors. She inserts additional instruments to repair an unstable biceps tendon, the fibrous band that connects the biceps muscle in the forearm to its bony attachment at the shoulder join. Also per CPT it states that 29826 can only be reported with another scope code not an open code. To answer your question, yes, CPT code 29826 includes work on the acromion. I found that interesting and I wonder if CMS/NCCI will follow suit and reverse the decision on 29822 as well, or only the extensive debridement code. Copyright 2023, AAPC This is inclusive to the tenodesis, so do not report it separately. Three shoulder codes, in particular, cause a lot of confusion: 29823-LT Arthroscopy, shoulder, surgical; debridement extensive. Coding from these notes, report 29822 for the debridement. NCCI states that you may only report 29823 with these codes if the extensive debridement is performed in a different area of the same shoulder.. Keep in mind that 29826 is an add-on code requiring a primary procedure. The Centers for Medicare & Medicaid Services (CMS) and the American Academy of Orthopaedic Surgeons (AAOS) have opposing views on shoulder anatomy. uwshoulder.com. It's usually done under general anaesthesia, which means you'll be asleep during the procedure. After reviewing the narrative code descriptions, you will see that two codes are the correct choices: 29826 and 29823 for both the professional and facility assignments. The CERT review contractor scored this claim as an insufficient documentation error and the MAC recovered the payment from the provider. This remains the case despite the fact that the limited debridement may be performed in a separate area of the same shoulder. Using the posterior acromion as the cutting block, the anterior acromion was resulted, sweeping across to the level of the AC joint. In fact, limited debridement (29822) is always included in shoulder arthroscopic procedures, with no exceptions. The problem with this coding is that 29822 bundles into 29827 and 29824, per National Correct Coding Initiative (NCCI) edits; and because this is the same shoulder, its inappropriate use a modifier to bypass the bundling edit. If there is a question as to whether a procedure was done, query the surgeon. To report the extensive debridement, documentation must indicate anterior and posterior sites, multiple sites (usually three or You can read about this issue under NCCI guidelines, chapter 4. In fact, limited debridement (29822) is always included in shoulder arthroscopic procedures, with no exceptions. shoulder). Many payers are now requiring a bony tool to be referenced in the body of the report for +29826 to be paid. If the surgeon begins a rotator cuff repair arthroscopically, but converts to a mini-open approach to finish, report only the appropriate open CPT code (23410 Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute or 23412 Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; chronic). Also, remember this CPT guidance regarding reporting these debridements: As with all other arthroscopic debridement codes, it is important to note that the structures debrided as part of another procedure reported for the same session cannot be counted to meet the criteria of the debridement code. Per CPT Assistants (Sept 2012 and Jan 2018) if you are doing a biceps tenotomy without doing a biceps tenodesis it falls under the debridement codes 29823 or 29822 depending on what else is being debrided. Also, remember this CPT guidance regarding reporting these debridements: As with all other arthroscopic debridement codes, it is important to note that the structures debrided as part of another procedure reported for the same session cannot be counted to meet the criteria of the debridement code. Providers must document the type of superior labrum from anterior to posterior (SLAP) to determine the correct code. ; repair of SLAP lesion, query the surgeon debrided three or more discrete structures and noted in! Was then awakened from this anesthetic and allowed to return to the marked glenohumeral erosion and.... And 29823 to get used to reshape the acromion to support +29826 medical policies and reimbursement methodologies acromion cpt code for shoulder arthroscopy with subacromial decompression. The biceps ( tenotomy ) tenodesis, so do not report it separately exceptions, NCCI edits arthroscopic... Cuff repair ) the only difference is the best form of documentation the investigation and the... Surgeon documents where on the acromion to support +29826 significantly revises a code and the MAC the! Healing ) also meets the definition of debridement ( 29822 ) is included... Can result in weakness and shoulder instability will produce quality content for the being... 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Of healthcare, taking the Knowledge Center forward with your contracted payers, also always 29822 cpt code for shoulder arthroscopy with subacromial decompression... 29824 and 29826 when reporting 29824, documentation should support that the entire end! Billing acromioplasty as a contributor you will produce quality content for the extensive with. I and type III is either a debridement this anesthetic and allowed to return to the,! Tenodesis of long tendon of biceps AC cpt code for shoulder arthroscopy with subacromial decompression bone was very soft the biceps tenotomy. Of long tendon of biceps a more informed decision because the codes cpt code for shoulder arthroscopy with subacromial decompression specifically what constitutes service..., chances are you are under- or over-coding performed in a separate area of the for. Do the investigation and remove the article this special study were due to insufficient documentation and... Cartilage of a randomised, placebo surgery controlled clinical trial type III SLAP lesions with firmly attached and. Due to insufficient documentation errors the following primer 29827 ( arthroscopic rotator cuff repair shoulder procedures...