Question 29823, 29827 Clarification 2021

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Hello!

I am reaching out to ask some questions regarding 29823. In an effort to explain to my providers the use of 29823, I want to make sure my understanding is accurate.
  • 29823 (Arthroscopy, shoulder, surgical; debridement, extensive 3 or more discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body[ies]))
The descriptor specifically lists the bursal or articular side, but my providers usually dictate by which tendon they are addressing and not whether it's bursal or articular sided. Is there a difference? Meaning, is one tendon bursal and the other articular? If so, which ones?

If my provider is performing 29827 (arthroscopic; rtc repair), and if all four tendons make up the rotator cuff, would it be fair to make the following interpretation?
Any debridement of the rotator cuff (supraspinatus, infraspinatus, teres minor, or subscapularis tendons) is inclusive to 29827 and therefore cannot be "counted" when considering structures debrided for 29823.

Any insight is greatly appreciated!!
 

Orthocoderpgu

True Blue
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Most restorative procedures (repairs) start with debridement: SLAP, tenodesis, RTC. The debridement that is performed as part of these repairs are not counted towards 29823. The debridement of tissue has to be done separate and not being repaired. You also need to go to the CMS NCCI Surgical Policy Manual as it has extensive instructions on 29822 and 29823.
 
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Location
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I appreciate the quick response! I've seen several of your posts over the last year as I've stepped into doing Ortho surgical coding and your responses have been extremely helpful to myself and the practice I work for as a whole. We are actually a team of fairly "new" coders and often seek guidance from the forums. So thank you very much for being an active participant and sharing your knowledge!!

I have been struggling with 29823 and validating it's use for some time now. I was hoping the updated description from 2021 would add a little more clarity to my struggle.

I've read the NCCI policy and I'll add it here as a reference:

Shoulder arthroscopy procedures include limited debridement (e.g., CPT code 29822) even if the limited debridement is performed in a different area of the same shoulder than the other procedure. With 3 exceptions, shoulder arthroscopy procedures include extensive debridement (e.g., CPT code 29823) even if the extensive debridement is performed in a different area of the same shoulder than the other procedure. CPT codes 29824 (Arthroscopic claviculectomy including distal articular surface), 29827 (Arthroscopic rotator cuff repair), and 29828 (Biceps tenodesis) may be reported separately with CPT code 29823 if the extensive debridement is performed in a different area of the same shoulder.

I understand that 29827, 29824, and 29828 are the only shoulder arthroscopy codes 29823 may be submitted with. I also understand that the work must be performed in a different area of the shoulder. The areas being the glenohumeral joint, acromioclavicular joint, and the subacromial bursal space. I think my question, and thus my determining factor comes down to the anatomy- of which I'm not exactly firm on.

What "areas" or "regions" are the different structures in the code listed?

My colleague and I have been referencing a case we get rather often and are trying to determine where each structure would be categorized.
So for example, the labrum, the biceps tendon, the middle glenohumeral ligament, the superior capsule, and the supraspinatus are debrided in addition to supraspinatus repair. Not counting the debridement of the supraspinatus tendon towards the number of structures debrided, I would code 29823 based on the CPT description (biceps tendon, labrum, caspsule). However per NCCI edits, the 3 structures would need to be in a separate area of the shoulder.

If the labrum and capsule are part of the glenohumeral joint, what about the supraspinatus and biceps tendon? What region would they be considered? What about the other tendons of the RTC?
 

Orthocoderpgu

True Blue
Messages
1,646
Location
Salt Lake City, UT
Best answers
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I appreciate the quick response! I've seen several of your posts over the last year as I've stepped into doing Ortho surgical coding and your responses have been extremely helpful to myself and the practice I work for as a whole. We are actually a team of fairly "new" coders and often seek guidance from the forums. So thank you very much for being an active participant and sharing your knowledge!!

I have been struggling with 29823 and validating it's use for some time now. I was hoping the updated description from 2021 would add a little more clarity to my struggle.

I've read the NCCI policy and I'll add it here as a reference:

Shoulder arthroscopy procedures include limited debridement (e.g., CPT code 29822) even if the limited debridement is performed in a different area of the same shoulder than the other procedure. With 3 exceptions, shoulder arthroscopy procedures include extensive debridement (e.g., CPT code 29823) even if the extensive debridement is performed in a different area of the same shoulder than the other procedure. CPT codes 29824 (Arthroscopic claviculectomy including distal articular surface), 29827 (Arthroscopic rotator cuff repair), and 29828 (Biceps tenodesis) may be reported separately with CPT code 29823 if the extensive debridement is performed in a different area of the same shoulder.

I understand that 29827, 29824, and 29828 are the only shoulder arthroscopy codes 29823 may be submitted with. I also understand that the work must be performed in a different area of the shoulder. The areas being the glenohumeral joint, acromioclavicular joint, and the subacromial bursal space. I think my question, and thus my determining factor comes down to the anatomy- of which I'm not exactly firm on.

What "areas" or "regions" are the different structures in the code listed?

My colleague and I have been referencing a case we get rather often and are trying to determine where each structure would be categorized.
So for example, the labrum, the biceps tendon, the middle glenohumeral ligament, the superior capsule, and the supraspinatus are debrided in addition to supraspinatus repair. Not counting the debridement of the supraspinatus tendon towards the number of structures debrided, I would code 29823 based on the CPT description (biceps tendon, labrum, caspsule). However per NCCI edits, the 3 structures would need to be in a separate area of the shoulder.

If the labrum and capsule are part of the glenohumeral joint, what about the supraspinatus and biceps tendon? What region would they be considered? What about the other tendons of the RTC?
Don't get caught up with "Regions". You need to have a sound understanding of anatomy and how the shoulder procedures are performed. There is no one size fits all answer since different procedures will be performed and performed in different combinations as well. If the debridement is part of a restorative procedure, it's bundled. If it's not part of a restorative procedure, you might be able to bill 29823.
 
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