More shoulder woes... 29823

[bethb]

I am getting really close to understanding this I am still a little confused about the reporting for the following scenario. I found that if a provider performs a subacromial decompression, biceps tenotomy, and debridement of the anterior labrum, CPT code 29823 can be reported. But can 29826 also be reported with 29823, for the acromioplasty?

Procedures stated by the ortho surgeon as

1. Left shoulder arthroscopy with limited labral debridement
2. biceps tenotomy
3. subacromial decompression

Surgeon is stating limited debridement, but I read that the labral debridement, plus the biceps tenotomy, plus the SAD, would justify billing the extensive debridement code 29823. Is my thinking correct?

But I am now wondering, or maybe overthinking, if 29826 can be reported with the 29823, since an acromioplasty was also performed?

Any advice or information is very much appreciated. Thank you.

 

[Orthocoderpgu]

Your answer is no. You cannot report 29826 for just performing the acromioplasty, you have to perform the decompression as well.

Keep in mind that 29822 cannot be reported with any other code now.

The debridement that counts towards 29823 cannot be part of a restorative procedure. For instance, the doc will debride a rotator cuff tendon before repairing it. Bone will be debrided before any anchors are placed. This debridement will not count towards 29823.

 

[bethb]

Orthocoderpgu, thank you very, very much. Your information helps! Would you be willing provide some advice with regards to billing for a biceps tenotomy, with a shoulder arthroscopy ( w/ limited debridement) and subacromial decompression / acromioplasty?

I have found conflicting information about billing. Some say report the biceps tenotomy as an unlisted CPT code, some say it is not reportable. One coder is saying this situation would be coded as 29822, 29826, and 29999 (biceps tenotomy).

Another coder is suggesting to report 29823, shoulder arthroscopy with extensive debridement, and not to report the biceps tenotomy, as it is included with the 29823, as it adds a level of debridement (qualifying the arthroscopy as "extensive debridement"). I cannot seem to come to a conclusion.

 

[Orthocoderpgu]

Coding for the biceps tenotomy is going to depend on the insurance. Medicare does consider it debridement. However, many insurance companies still pay for this with the unlisted 29999 and compare to 23405. Most of the time it will deny just because an unlisted code is being billed, however, if you show the insurance that there is an open code for the same procedure, it does get paid.

You will have to learn by trial an error which insurance companies will pay and which will not. Just have a good appeal letter ready.

In the appeal really stress that this is the same procedure as 23405 only performed arthroscopically instead of open. And point out that there is separate pathology for it. Usually torn.

If the biceps is fairly healthy, the physician will often perform a tenodesis. However, if the tendon is too degenerative for a tenodesis procedure, the only option is the tenotomy. Make sure and point that out in your appeal letter that the tenotomy is the procedure of last resort, otherwise a tenodesis would have been done.

 

[bethb]

Orthocoderpgu,

Thank you so much for the information you have shared with me!