Outpatient Facility Coding Alert

Edit Update:

Good News: Some Shoulder Arthroscopy Edits Are About to Be Reversed

Published on Thu Jun 16, 2016

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The change will take place in July.

Arthroscopy procedures are commonplace in outpatient facilities, which means you need to always be in-the-know about any changes. A welcome shift to how you should report extensive debridement code 29823 with other arthroscopy codes will soon come your way, thanks to National Correct Coding Initiative (CCI) edits. You can breathe a sigh of relief as CMS and CCI are reversing their policy that bundles the codes together.

Timeline: These changes will take effect in the next release of CCI edits slated for July 1, 2016.

Previously, when you reported 29823 (Arthroscopy, shoulder, surgical; debridement, extensive) with any of the following codes, you were only paid for the following codes:

29824 — … distal claviculectomy including distal articular surface (Mumford procedure)
29826 — … decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (List separately in addition to code for primary procedure)
29828 — … biceps tenodesis.

As of July 1, you will be able to report these code combinations (29824/29823, 29826/ 29823, 29828/29823) and receive payment for both codes.

Warning: “This is wonderful news, but it means that surgeons must be very specific in their documentation of extensive arthroscopic debridement,” says Heidi Stout, BA, CPC, COSC, PCS, CCS-P, Coder on Call, Inc., Milltown, New Jersey. “Failure to do so will result in the payer down-coding to 29822 (… debridement, limited) and denying.”

Example 1: A surgeon does an arthroscopic distal clavicle excision (29824) and, inside the gleno-humeral joint, does debridement of the labrum in both the anterior and superior portions of the joint. Debridement in both the anterior and posterior gleno-humeral joint qualifies for extensive debridement, so the surgeon may code for 29823, and because of the new rule, may also code this along with 29824.

Example 2: A surgeon performs arthroscopic extensive debridement of the anterior, superior, and posterior glenoid labrum and a partial rotator cuff tear along with arthroscopic distal clavicle resection. At this time, CCI allows you to report only code 29824; after July 1, you will be able to report codes 29824 and 29823. “The onus is on the surgeon to classify their debridement as limited or extensive by describing it as such in their documentation,” Stout says.