Orthopedic Coding Alert

Question: How should I code an arthroscopic excision of a bursa in the shoulder when surgical notes state that the physician did not perform a decompression?

Alabama Subscriber

Answer: Your code choice will depend on whether your physician performed a limited or extensive excision:

• 29822-- Arthroscopy, shoulder, surgical; debridement, limited

• 29823-- ... debridement, extensive.

The debridement often requires an acromioplasty, which is code 29826 (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)). Keep these tips in mind, however, before adding 29826 to your claim:

• Do not report 29826 if your surgeon’s notes don’t mention acromioplasty.

• You can report 29826 with 29822 if your surgeon performs limited debridement in the GH joint, in addition to acromioplasty.

• You sometimes can report 29826 with 29823, depending on the circumstances.

Example: If the physician completes both the acromioplasty and debridement within the subacromial bursa and you have supporting documentation, you’ll report only 29823. If he completes acromioplasty within the subacromial bursa and the debridement within another area (such as in the gleno-humeral [GH] joint), you can submit both codes.