Wiki Shoulder Arthroscopy

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misnkm

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Hi,
I am new to Ortho and have a denial for 29823-51-RT. We have a billing company handling our charges/payments. I am reviewing denials and have the following billed: 29827-RT, 29828-51-RT,29823-51-RT and 219826-RT. I can't find any reason why the 29823 is denying. It is denied with a 97, included in another service billed this day. Can someone please educate me?
Thanks
Missy
 
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without seeing the op note no

29823 is for debridement that is NOT in preparation for a restorative procedure. And it would not be common to bill 29823 with 29826.

My guess is that the coding is inaccurate.
 
Shoulder arthroscopic procedures and debridement per NCCI manual

The NCCI Manual states:
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.
So I would bill 29823 with a modifier 59 if the debridment is performed in a different area of the same shoulder.
 
Per encoder pro expert

None of those codes are bundled. Per CPT Use 29826 in conjunction with 29806-29825 and 29827, 29828. The debridement does need to be separate from the prep for the RCR.
 
2018 AAOS guidelines on Arthroscopic Shoulder Codes

In addition, AAOS came out with the following guidelines earlier this year in the March 2018 issue:

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"Arthroscopic shoulder procedures
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The traditional coding rule about the shoulder is to consider the joint as one compartment. Due to continuous efforts by orthopaedic societies, a two-compartment (intra- and extra-articular) viewpoint is gaining acceptance. As a
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result, a few coding rules have changed. Intra-articular structures include the labrum, the long head of the biceps, a Bankart lesion, and the humeral and glenoid articular surfaces. Extra-articular structures include the rotator cuff
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(RC), the distal clavicle, and the subacromial space."

I would request that the surgeon be very clear in the documentation the location of the the repairs vs debridement. In your example, the doctor is already working in both the intra- and extra-articular spaces (long head of biceps, rotator cuff and subacromial space. Documentation should support that the debridement was medically-necessary and not for visualization of the repaired structures.

Further, while there is no NCCI edit in place for the 4 codes, Medicare and other carriers have routinely denied the 29822-3 as being included in more extensive arthroscopic shoulder procedures, so I would place a -59 or -XS modifier on the 29823 and file and appeal with the documentation showing debridement as medically-necessary.

Welcome to Ortho coding and good luck!
Alicia
 
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