Extensive debridement glenohumeral joint 29823 ?

[betsycpcp]

Is it appropriate to bill 29823 in this case?

Operative report:
1- left shoulder arthroscopic type II superior labrum anterior and posterior repair (29807).
2- arthroscopy, shoulder, with subacromial decompression (29826).
3- arthroscopy, shoulder, with acromioclavicular joint resection (29824).
4- arthroscopy, shoulder, with extensive glenohumeral joint debridement (29823).

Indications: patient is status post left shoulder continued complaints. He failed conservative treatment and was scheduled for surgery.

Operation: The patient was prepped and draped in the normal sterile fashion in the operative suite. The anterior and posterior arthroscopy portals were established. The joint was surveyed. There was a labral tear anteriorly. It was a type II SLAP variety. This was debrided with the shaver and then reapproximated using a 2.4 anchor and tied nicely with a Weston knot. The anterior-inferior labrum was debrided. The partial articular rotator cuff tear was debrided with the shaver. The subacromial space was breached, and decompression was done using the bur, the shaver, and the Arthrocare device to convert the type III acromion to a type I acromion. The distal 8 mm of clavicle was excised with the bur and the shaver. The wounds were copiously irrigated with normal saline. The skin incisions were reapproximated with 4-0 nylon.


Does it seem like there is enough there to justify 29823 (or even 29822)? Any help will be appreciated.

[mousehouse1]

I think I would go with 29822 :
Limited fraying cartilage is debrided using a debridement tool and suction devices.

Code Scope
•The physician performs limited labral debridement, cuff debridement or the removal of degenerative cartilage and osteophytes using an arthroscopic approach.

This is a description of 29823 :
Extensive fraying cartilage is debrided is using a debridement tool an suction.
Code Scope
•Debridement typically is performed in the anterior AND posterior shoulder.
•Articular cartilage but no soft tissue is removed.
•The joint will be explored arthroscopically.
•Both the front and back of the shoulder is incised and debrided

[nyyankees]

I agree with 29822 - you'll lose the labral debridement on 29807. Just can capture RC debridement.

[betsycpcp]

Thanks for your answers!