Question Limited vs Extensive?

ahodge90

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I was taught that a limited would be debridement of a single area like the cuff, labrum or bicep tendon, or a chondroplasty of the glenoid OR humeral head and that an extensive would be a chondroplasty of BOTH the humeral head and glenoid, or a chondroplasty of the glenoid or humeral head and debridement of the cuff, labrum or biceps. I know we cannot count the superior, posterior and anterior labrum as separate areas, it all counts as one, and that if a debridement is done of the cuff or labrum but then a repair happens then all I can code is the repair.

So, with all this said, I have case where the doc did a debridement of the labrum, and the cuff, and also did a bicep tenodesis with a SAD with acromioplasty. then proceded to do an open distal clavicle excision. I see that 29826 is bundled with my open distal clavicle excision, I am pretty sure that I should not code the 29826, but what I don't understand it the 29822 vs 29823. With what I mentioned earlier, am I supposed to code this as 29823 because multiple areas were debrided here?
I was hoping I could get clarification on 29822 and 29823, because I see that the 2021 CPT book updated their description of these codes. I saw that these codes now say that if there is 1-2 areas it falls as limited and 3 or more areas means it falls as extensive. I was curious if the way that I was taught on these codes are the way that I am supposed to be coding these or if this is just how to code these until the new 2021 codes come into effect.
 

Orthocoderpgu

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Keep in mind that if the doctor debrides a rotator cuff tendon and then performs 29827, that debridement is included with 29827 not 29822 or 29823. Same with biceps tendesis. The surgeon will always debride the tendon and bone which is the starting point of a tenodesis procedure. None of this can be counted towards 29822 or 29823. Additionally 29822 cannot be paired with any other code even if the debridement was performed in a separate area. Code 29823 can only be billed with 29824, 29827 or 29828 and must be totally unrelated to these procedures.
 

Orthocoderpgu

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ok, so just to make sure I am understanding this based on what you said here,
it looks like me doc did the 29828 here because of the SLAP tear. he released the biceps here and then did the debridement of the superior labrum then did suturing of the biceps, along with the debridement superior cuff. and then proceeded with the open distal clavicle excision. So are you saying that because the SLAP is related to the biceps that I shouldn't code this as a separate area for the debridement?
To answer your question: correct. You can find this in the CMS NCCI Surgical Policy Manual. Code 29822 cannot be reported with any other code since it's limited debridement and is included even if performed in a separate area and 29823 can be billed if the debridement is not related to a restorative procedure, so it would basically need its own unrelated pathology in order to support the code.
 

ahodge90

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To answer your question: correct. You can find this in the CMS NCCI Surgical Policy Manual. Code 29822 cannot be reported with any other code since it's limited debridement and is included even if performed in a separate area and 29823 can be billed if the debridement is not related to a restorative procedure, so it would basically need its own unrelated pathology in order to support the code.

Thank you very much for explaining this!! Shoulders are super tricky for me because of all the edits that are involved. I like the new description that they have on these codes, between this information and what is in the book, maybe I will better understand this in time.
 

Orthocoderpgu

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Speaking of edits, you can't use -59 or -XS to bypass a shoulder edit. Per the surgical policy manual if the codes hit an edit, they can't be bypassed with a modifier and can only be billed together if they are performed on separate shoulders. I've never seen that.
 

ahodge90

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Speaking of edits, you can't use -59 or -XS to bypass a shoulder edit. Per the surgical policy manual if the codes hit an edit, they can't be bypassed with a modifier and can only be billed together if they are performed on separate shoulders. I've never seen that.
I did not see that, but I am going to make a note on this for the future. Thank you for that!
 

ahodge90

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Speaking of edits, you can't use -59 or -XS to bypass a shoulder edit. Per the surgical policy manual if the codes hit an edit, they can't be bypassed with a modifier and can only be billed together if they are performed on separate shoulders. I've never seen that.

I just wanted to make sure that this would still apply in this situation..
I have a shoulder scope debridement-29822
and a 23120. They are bundled together. So, because of what you have mentioned earlier about the 59 on shoulders, would I be correct to say that I cannot bill 23120 with 29822-59 even if there are two separate incisions that were made?
 

Orthocoderpgu

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That's the way I see it. If you look at the surgical policy manual it states that all debridement is included except extensive debridement and even then is restricted and must be paired with 29824, 29827 or 29828. Also keep in mind that the edit is still there even though one is open and the other arthroscopic.
 

ahodge90

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That's the way I see it. If you look at the surgical policy manual it states that all debridement is included except extensive debridement and even then is restricted and must be paired with 29824, 29827 or 29828. Also keep in mind that the edit is still there even though one is open and the other arthroscopic.

Ok, thank you!
 
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