29823 extensive intra articular debridement

mitcheek1

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Hello, I work for an orthopedic office and they do a lot of shoulder video arthroscopy's. It is always stating they are doing an extensive debridement, I just wanted to make sure that they are up to standards for billing this code and its not inclusive of another procedure done this day.

Report reads Extensive intra-articular debridement of anterior superior posterior labrum, rotator cuff interval, bursa, synovium, rotator cuff tear.
Provider also performed a rotator cuff repair, biceps tenodesis and subacromial decompression. All of this is documented.

Within the op report he has An extensive thorough debridement of the anterior superior and posterior labrum and also the rotator cuff interval was performed. We also thoroughly debrided the area of the full-thickness rotator cuff tear, intra-articular synovium and bursal tissue above the tear. The subscapularis tendon was intact. The biceps tendon had tearing and a tenodesis was performed with dorsal cord suture and a 4.5 Park's anchor. The scope was placed in the subacromial position an the full thickness rotator cuff tear was debrided the rotator cuff was repaired with a dual row technique utilizing parkers anchors. Probing confirmed the repair to be quite stable. A subacromial decompression was performed with a bur converting the acromion to a smooth flat type I surface. We thoroughly irrigated closed and so on.

Thank you in advance
 

amyjph

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Hi,

Read the CPT description of 29823 well, it was updated and now states what is required (and gives examples) to report extensive debridement.
  • CPT 29823 — Arthroscopy, shoulder, surgical; debridement, extensive, 3 or more discrete structures (e.g., 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])
You must also consider what other procedures are being performed at the same time such as rotator cuff repair, biceps tenodesis, SAD, DCR, etc. This will impact your coding. Depending on the payer (MCR etc.) you need to also consider NCCI guidelines. Check the NCCI policy manual CHAPTER IV SURGERY: MUSCULOSKELETAL SYSTEM, E - Arthroscopy. 7. 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.

With the info from your op report above, the debridement of the rotator cuff and biceps tendon would not be separate because it looks like a tenodesis, RCR and SAD were performed and work done on those structures would be part of those codes. That leaves you with debridement of the labrum, bursa and synovium but because of this statement, "intra-articular synovium and bursal tissue above the tear." I don't know that I would try to go for 29823 separately. Was there any bony work done?

There are many times the provider will call out extensive debridement and not indicate what structures, it needs to be described clearly in the operative report.

The AAOS and Zupko are good resources for this information too.
 
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