29806 and 29807 coding with 29823


Haverhill, Massachusetts
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Hello all,

As of 7/1/2016 we were able to code 29823 with 29827 and 29824 without it hitting against each other and getting paid. My question is why does the same rule not apply to the 29806 and 29807?


True Blue
Salt Lake City, UT
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Hopefully in time the edit will be dropped for more shoulder procedures. Until then, we have to take it in baby steps. Codes 29827 and 29824 were only used as an example by AAOS when they met with CMS. The same rationale should be used for all procedures. Years ago CMS made the decision that the shoulder was one anatomic location. Hence, if you performed a distal clavicle resection (29824) and debrided the humeral head for chondromalacia (29823), even though these are anatomically unrelated, CMS bundled them.

Let's say your doc repairs a RTC (29827). Before they do, they will debride the tendon of frayed edges before anchoring it down. This debridement is not included in 29823. Any debridement that is part of a repair cannot be counted towards 29823.

However, there is a ton of debridement performed that is not performed as a part of another restorative procedure, so our docs are being ripped off since CMS does not recognize that the debridement is separate from the debridement that is done that is part of a surgical repair.

We have made a small baby step in the right direction. Let's hope that AAOS keeps pushing CMS and get the edits dropped on more procedures in the future.