Orthopedic Coding Alert

Look for other open, arthroscopic procedures and confirm with payers.

Having a little extra practice applying CPT® code +29826 (Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament [i.e. arch] release, when performed [List separately in addition to code for primary procedure]), when your surgeon does another scope as the primary procedure will serve you well this year. Take a look at some common scenarios to help you ramp up your +29826 accuracy.

(See Orthopedic Coding Alert, Vol. 15 No. 4 for more advice on reporting +29826 in 2012).

3 Possibilities Narrow Your Choices

When reading an operative note, you need to focus on the work your surgeon did to understand which procedure was done in which compartment. Either your surgeon does an arthroscopic acromioplasty alone, or does one with an open procedure, or with another arthroscopic procedure on the shoulder:

Example 1: You may read that your surgeon performed an open rotator cuff repair with acromioplasty and extensive subacromial debridement. "In this case, you report 23412 (Repair of ruptured musculotendinous cuff [eg, rotator cuff] open; chronic), 29823 (Arthroscopy, shoulder, surgical; debridement, extensive)-51 (Multiple Procedures...)," says Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner, Precision Auditing and Coding, senior orthopedic coder & auditor, The Coding Network, Washington. Here you'll pick up the two procedures -- the open repair of the cuff and the extensive arthroscopic debridement -- and report the two as multiple procedures with modifier 51.

Example 2: You may read that your surgeon did an arthroscopic extensive intra-articular (glenohumeral) debridement with acromioplasty. "In this case, you report codes 29823 and +29826 (Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament [i.e. arch] release, when performed [List separately in addition to code for primary procedure]) and you do not append the modifier 51," says Stumpf. Thus, you report the extensive arthroscopic debridement and the subacromial decompression. Note that +29826 is an add-on code here and there isn't a need for modifier 51.

Example 3: If you read that your surgeon does an arthroscopic acromioplasty alone, you turn to code 29822 (Arthroscopy, shoulder, surgical; debridement, limited) or 29823 based on the extent of the debridement your surgeon does, limited or extensive.

"Code 29823 requires debridement in either the anterior and posterior aspects of the gleno-humeral joint or both the gleno-humeral joint and sub-acromial bursa, to qualify," says Bill Mallon, MD, medical director, Triangle Orthopedic Associates, Durham, N.C.

Confirm With Your Payers

The change to add-on status for 29826 in 2012 has caused payment delays and denials, so it's best to check your payers' policy before submitting claims."Changes to the 2012 guidelines for CPT® code 29826 are still ongoing and more changes may be coming down," says Stumpf. "Coders should carefully watch this scenario unwind to keep on top of the changes as they arise. It appears as if carriers are also having difficulty implementing the changes. Some appear to be still paying at the old allowable, which may drive take-backs and claims adjustments as the carriers update their system."