Wiki Shoulder Arthroscopy Procedures and debridement

[aterry1104]

Please help me understand when I can bill for shoulder debridement if a our doctor bills 29827 my understanding is that we can only can report 29823 if extensive debridement is performed in a different area of the same shoulder am I on the right track? Any additional help or guidance would be appreciative

Thanks

Andie Terry-CPC-P

 

[AlanPechacek]

The CPT Code 29827 is for Arthroscopic Rotator Cuff Repair, and includes all the elements of 29826. 29827 is an "extension" of 29826. Any Debridement of tissues done in 29826 is included in 29827 in that any "debridement" of tissue done to prepare the Rotator Cuff Tendons and the site of reinsertion/attachment/repair is included. This particular "debridement" can't be coded (i.e. 29823: Extensive Debridement) and charged separately. If, however, there is another site of shoulder joint pathology, not related to the above, which is identified and treated by Limited Debridement (29822), with that pathologic lesion clearly documented as separate and coded for diagnosis, and the rationale/indications for that Limited Debridement are documented, you "might" be able to code that and charge for it with a Modifier such as 51, possibly 22 or 59 (which may too complicated to use), but, don't bet on it going through without the proper documentation, i.e. the Operative Report. More likely than not, the payer will try to bundle it into the Rotator Cuff Repair procedure code and deny the additional procedure.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com

 

[amyjph]

This is the new language in the NCCI edits, 29823 no longer hits against 3 shoulder scope codes.

"4. CMS considers the shoulder to be a single anatomic
structure. With three exceptions an NCCI procedure to procedure
edit code pair consisting of two codes describing two shoulder
arthroscopy procedures should never be bypassed with an NCCIassociated
modifier when the two procedures are performed on the
ipsilateral shoulder. This type of edit may be bypassed with an
NCCI-associated modifier only if the two procedures are performed
on contralateral shoulders. The three exceptions are described
in Chapter 4, Section E (Arthroscopy), subsection 7.
5. With the exception of the knee and shoulder,
arthroscopic debridement should not be reported separately with a
surgical arthroscopy procedure when performed on the same joint
at the same patient encounter. For knee arthroscopic debridement
see the following subsection. For shoulder arthroscopic
debridement see the second subsection following this one.
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 three 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.

I use AAOS guidance on when to report extensive debridement. This is from an old post but in my opinion the debridement advice is still valid:
http://www2.aaos.org/bulletin/apr06/coding2.asp
Code 29822 covers limited debridement of soft or hard tissue and should be used for limited labral debridement, cuff debridement or the removal of degenerative cartilage and osteophytes.

Code 29823 should be used only for extensive debridement of soft or hard tissue. It includes a chondroplasty of the humeral head or glenoid and associated osteophytes or multiple soft tissue structures that are debrided such as labrum, subscapularis and supraspinatus.