Wiki Loose shoulder body and extensive debridement

[michaelloss]

I received a denial for 29819 coded with 29823. First is removal of loose body, it was 2cm, shaved first and removed when small enough through a portal, no extra incision. 29823 was extensive debridement of humeral head, labral tear and ticking chondral defect. Margie Vaught claims AAOS says it is ok for LB removal over 5mm [2cm is a little over that]. Insurance co claims that AAOS requires separate incision. If you read 29823 it says that w/o size moniker. Anyone have AAOS citation as per Margie? Thank you, Michael Loss.

 

[mbort]

Here it is:

http://www2.aaos.org/aaos/archives/bulletin/aug03/code.htm

Mary, CPC, COSC

 

[michaelloss]

Above info not really correct

The citation above of Margie can't be documented with AAOS. AAOS 2009 edition states that it must come out through a separate incision. Margie says otherwise in her seminar's which I have attended but what she says in a seminar or article is not recognized by insurance companies or necessarily accepted as gospel by AAOS. Does anyone have AAOS documentation? Thank you, Michael.