Help w/ difference in 29822 (limited) and 29823 (extensive)

CoderinJax

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Hi,

I'm hoping someone can assist me with a chart and show whether 29822 or 29823 would be the appropriate code. I've read thru multiple forum posts, but most are from 2009 and I'm not sure how accurate the information is any longer, and some links didn't work that were attached. I've also read multiple articles and still need some assistance.
I'm going to post the part of the chart that I'm in need of the most:

"A shaver was brought in and debridement was done of the labrum and debridement of the rotator cuff and the tuberosity were also completed.


The scope was then placed up into the subacromial space. A lateral portal was made after localization with a spinal needle. A bursectomy was performed with the shaver. An Acromioplasty was then performed in standard fashion. The subacromial ligament was noted incised and was indeed preserved.

The tuberosity was debrided down to bleeding bone. An accessory lateral portal was made off the lateral border of the acromion. Additionally, prior to moving to the subacromial space, the biceps tendon was released with cautery-type device at its insertion into the labrum................."

My physician coded this portion as 29822/29826, and 29828. (There were more details to support the 29828 in the record, but my main focus are the 29822 and 29826 portions.)

Do you agree that it was truly only a 29822 and not a 29823? If so, why? What part tells me that 29826 was done? (The acromioplasty?)

Thank you all so much!
 

Orthocoderpgu

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Any debridement that is in preparation for a procedure is part of that procedure and is not reported. An example of that would be a RTC tendon in preparation for the repair. I would say that the debridement for this note is 29822 due to labrum and RTC debridement. The debridement of the tuberosity down to bleeding bone would be in preparation for the biceps tenodesis, so that would not be reported.

Generally speaking, you need three soft tissues areas to get to a 29823.

You need to have an acromioplasty documented for the 29826. If a SAD is done for visualization: not reported. If it's done due to pathology, and no acromioplasty is performed, you can use this and count it as one of your three areas needed.

If you debride a soft area and then some bone, which happens in the shoulder frequently on the articular surface then you would do 29823 as a general rule.

Labrum has to be from Anterior to Posterior to qualify for 29823.

I hope this helps.
 

CoderinJax

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Any debridement that is in preparation for a procedure is part of that procedure and is not reported. An example of that would be a RTC tendon in preparation for the repair. I would say that the debridement for this note is 29822 due to labrum and RTC debridement. The debridement of the tuberosity down to bleeding bone would be in preparation for the biceps tenodesis, so that would not be reported.

Generally speaking, you need three soft tissues areas to get to a 29823.

You need to have an acromioplasty documented for the 29826. If a SAD is done for visualization: not reported. If it's done due to pathology, and no acromioplasty is performed, you can use this and count it as one of your three areas needed.

If you debride a soft area and then some bone, which happens in the shoulder frequently on the articular surface then you would do 29823 as a general rule.

Labrum has to be from Anterior to Posterior to qualify for 29823.

I hope this helps.


This was a TREMENDOUS help! I don't code a lot for the ortho side, but it's always been interesting. I really appreciate your reply and it makes sense. Is this knowledge stored in your brain, or do you know of anything I can show to support why the 29822 shouldn't have been coded (and that it doesn't qualify for 29823)?
 

Orthocoderpgu

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There is an article in the Healthcare Business Monthly (I hate that, I still want to call it the Coder's Edge) March of this year. His resource for the article was AAOS Bulletin April 2004. If you Google AAOS debridement you should find the bulletin no problem.
 

CoderinJax

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Ha, I always want to call the magazine by the old name as well!
I brought several documents home with me last night and read them to gain a better understanding, and I have to tell you your response truly made a light bulb come on! I just kept reading (over and over) what you mentioned and compared it to the record/chart and it makes sense! I don't hang out much in the ortho field (aside from maybe the spine, but that's only because I've had a couple of lumbar fusions, etc so I'm intrigued by what they've performed on me, lol) so any chance to learn, I'm going to take it.
Thank you SO much again. Have a great Thursday! :cool:
 
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