Arthroscopic Shoulder Debridement Bundles Bicep Tenotomy

Arthroscopic Shoulder Debridement Bundles Bicep Tenotomy

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Q: We recently (2014 charges) reported for a Medicare patient:
29827-LT Arthroscopy, shoulder, surgical; with rotator cuff repair-Left side
29823-59-LT Arthroscopy, shoulder, surgical; debridement, extensive-Distinct procedural service
29819-59-LT Arthroscopy, shoulder, surgical; with removal of loose body or foreign body
+29826-LT 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)
29999 Unlisted procedure, arthroscopy
Medicare denied the unlisted code (the bicep tenotomy) as non-covered. Should we have appended modifiers to 29999? CPT® advises that when arthroscopy is performed with arthrotomy, to add modifier 51 Multiple procedures.
Or perhaps the tenotomy is a bundled procedure?
— Kathleen Smith, CPC/ARII
A: Modifier application isn’t the issue. Your suspicion that the bicep tenotomy is a bundled procedure is correct. Specifically, the tenotomy is bundled to the debridement (29823). CPT® Assistant, September 2012 advises:

Question: My physician performs an arthroscopic shoulder procedure in which a tenotomy of the biceps is done to complete debridement. What code would I use to report this procedure?
Answer: From a CPT coding perspective, because the biceps are tenotomized at the time of the debridement, only the debridement should be reported. Code 29822 Arthroscopy, shoulder, surgical; debridement, limited or code 29823 Arthroscopy, shoulder, surgical; debridement, extensive, should be reported based on the extent of the service provided.

A final note: Despite CPT® advice, many payers no longer require the use of modifier 51. Check with your payer for specifics.

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John Verhovshek
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John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

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