Orthopedic Coding Alert

Don’t let 1 missing sentence lead to a denial.

Shoulder arthroscopy procedures can present unique coding challenges, particularly when surgeons perform additional work that extends beyond a standard repair. Two areas that frequently attract payer scrutiny are Bankart repairs with remplissage and arthroscopic synovectomy procedures. In both cases, reimbursement often hinges on the provider’s procedure notes, which need to include details like the extent of the work performed, why it was medically necessary, and what the patient attempted before surgery was decided upon. During their HEALTHCON 2026 presentation, “Denial Trends and Resolutions in Orthopedics,” Lynn Anderanin, coding compliance manager at EmergeOrtho, and Cheryl Patterson, coding manager at EmergeOrtho, brought solutions to these problems.

Read on the learn what payers expect to see in the operative report and how to identify documentation gaps before a claim is submitted.

Review Remplissage and Bankart Procedures

The first example of a common orthopedic procedure denial Patterson shared with the audience was remplissage, a minimally invasive shoulder surgery performed arthroscopically to treat anterior instability by filling a humeral head bone defect or Hill-Sachs lesion.

There are two paths for coding this procedure, per Patterson:

If the practitioner also performed what is referred to as a “Bankart repair,” you will use 29806 (Arthroscopy, shoulder, surgical; capsulorrhaphy) — use this when the payer considers the procedure as part of the joint stabilization. You will also append modifier 22 (Increased procedural services) because of the requirement of added time, complexity, and distinct steps during the procedure. Be sure to include this information in the notes you submit with your claim.

Bankart repair defined: This is an orthopedic surgical procedure used to treat recurrent anterior shoulder instability, most often after a shoulder dislocation. A Bankart lesion occurs when the labrum (the ring of cartilage around the shoulder socket, or glenoid) tears away from the front of the socket during a dislocation.

If your practitioner did not perform a Bankart repair, you will use unlisted code 29999 (Unlisted procedure, arthroscopy) for an arthroscopic remplissage, which will also require you to include proof of a distinct non-included procedure. “When using 29999, you might list the anchor and portal locations separately,” said Patterson.

Know the Common Denial Reasons for Bankart Repairs

Patterson gave a few examples of the most common documentation reasons she sees in denials for Bankart repairs in her office:

• No clear description was given of engaging Hill-Sachs lesion
• Remplissage steps were not described as distinct from the Bankart repair
• Anchors/portals for remplissage were not documented separately
• No statement was written for the added time/complexity for modifier 22 usage

She then provided the following sample note to help avoid future denials on these procedures: “After completing the Bankart repair, a separate posterior portal was used to address the engaging Hill-Sachs lesion, two anchors were placed in the defect, and sutures were passed through the infraspinatus and posterior capsule to perform capsulotenodesis. This required an additional 25 minutes and represents work not included in the standard Bankart repair.”

Study Synovectomy Procedure Coding

A synovectomy is an arthroscopic procedure performed to remove inflamed, thickened synovial tissue (the lining of the joint capsule), a procedure which is similar to debridement. Patterson noted that a synovectomy often bundles with other arthroscopic procedures, but it’s important to understand when it does and does not.

To code synovectomy procedures, you will look to the following codes:

• 29820 (Arthroscopy, shoulder, surgical; synovectomy, partial)
• 29821 (… synovectomy, complete)

“These codes are divided by ‘limited’ and ‘extensive’ similar to debridement, so it’s based on areas. Limited is based on one focal area and extensive is going to be across multiple regions,” said Patterson. When using 29821, be sure to describe the full extent of the work done during the procedure and name the compartments that were affected. Bundle edits prevent you from billing this code with most other shoulder codes.

To avoid a denial, Patterson recommended adding these key elements to your synovectomy notes and claim forms:

• Diagnosis and laterality: Specific shoulder synovitis code
• Regions treated: Anterior capsule, posterior capsule, inferior recess, etc.
• Extent: Describe all of the compartments involved in the procedure
• Technique used: Radiofrequency (RF) ablation, shaver debridement of inflamed synovium
• Medical necessity: List what the patient has tried in the past and why they require the procedure by listing things like failed use of nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy (PT), injections; functional impairment.

The payer needs to know what is being performed and why.

Recognize the Common Denial Reasons for Synovectomy Procedures

Missing documentation proving why you’re billing the synovectomy procedure separately from other arthroscopic procedures is another common denial reason.

Patterson provided clear examples of phrasing that will cause denials on synovectomy claims:

• “Debridement performed” without specifying type of synovectomy performed
• “Inflamed tissue cleaned up” (too vague)
• “General synovitis treated” (you need to list the regions that were treated)
• “Cleaned fraying” (this will be interpreted as debridement)

Learn Tips for Successful Synovectomy Claims

To prevent missing information causing your denial, Patterson provided the following tips for your documentation.

If the synovectomy was performed with a rotator cuff repair or decompression for example, she advised adding a distinction statement to prevent the payer from bundling the work. “A phrase like, ‘Synovectomy was performed in separate, distinct compartments from the area of cuff repair and required independent surgical effort,’ would help with this,” said Patterson. She went on to say that using phrasing like this can prevent modifier scrutiny and bundling tendencies.

Here are some other phrases that will help prevent denials on your synovectomy claims:

• “Synovectomy performed in the anterior, posterior, and inferior recess compartments”
• “Hypertrophic inflammatory synovium excised using RF and shaver techniques”
• “Extensive synovectomy requiring independent effort separate from other procedures”
• “Pathologic synovium removed circumferentially across multiple compartments”
• “Focal synovectomy limited to the rotator interval only” (supports work for 29820)

Patterson provided sample dictation of a synovectomy procedure for the audience:

Using a combination of RF ablation and a motorized shaver, a circumferential synovectomy was carried out. Synovial tissue was excised from the anterior and posterior capsules, axillary recess, and rotator interval, removing inflamed tissue down to healthy capsular margins. The synovectomy required extensive work across multiple compartments to restore visualization and address persistent inflammation.

Lindsey Bush, BA, MA, CPC, Production Editor, AAPC