Debridement: Distinguishing Limited from Extensive
CPT®/AMA guidelines aren’t much help to distinguish limited versus extensive debridement, as described in CPT® codes 29822 Arthroscopy, shoulder, surgical; debridement, limited and 29823 …extensive, and 29837 Arthroscopy, elbow, surgical; debridement, limited and 29833 …extensive.
For example, a “Frequently Asked Question” in the April 2012 CPT® Assistant instructs, “…if a subacromial decompression is performed alone, which usually involves debridement of soft tissue and bone removal, then code 29822 may be reported…. If there is extensive work done in the removal of the soft tissue and bone, then one would report 29823.” The answer fails to provide an objective definition of either “limited” or “extensive.”
To give providers and coders direction, the American Academy of Orthopedic Surgeons (AAOS) has offered specific guidance on this issue:
Code 29822 covers limited debridement of soft or hard tissue and should be used for limited labral debridement, cuff debridement, or the removal of degenerative cartilage and osteophytes.
Code 29823 should be used only for extensive debridement of soft or hard tissue. It includes a chondroplasty of the humeral head or glenoid and associated osteophytes, or multiple soft tissue structures that are debrided such as labrum, subscapularis and supraspinatus.
Similarly, the April 2004 AAOS Bulletin advises, “…(29822) would consist of work done in just a portion of the shoulder, such as the front or the back of the shoulder. To support … (29823), the documentation should support work in BOTH the front and back of the shoulder.”
By applying the same concept to the elbow, a limited procedure (29837) occurs in either the anterior or posterior compartment of the elbow, while extensive procedure (29838) occurs in both the anterior and posterior compartments.
Debridement Documentation Tip
Effective documentation will identify the exact areas/compartments in which debridement takes place. Debridement in a single area or compartment is limited, while debridement in multiple locations/compartments of either the shoulder or elbow joint is extensive.