Shoulder debridement coding

SirCodesAlot07

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Stuart Sailfish Chapter
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I am struggling with Medicare on when(if) to code for debridement. I understand that you can not bill for limited debridement when any other ARTHROSCOPIC procedure is performed, but what if an OPEN procedure is performed.
For example 23412 and 29822 (obviously the debridement would not be for anything related to the rotator cuff repair).

Just recently Medicare has also been denying and recouping for billing for an extensive debridement (29823) with open procedures as well.

I have googled, read forums, read the NCCI manual, etc. and get conflicting information. Even the CMS RAC and NCCI audits seem to conflict each other. Can someone please help clarify? I want to make sure my team is coding correctly, but I also want to make sure we aren't down coding and missing revenue. Thank you!!!

This is from the CMS RAC

MAC Jurisdiction
All A/B MACs
Description
Shoulder arthroscopy procedures include a limited debridement (CPT code 29822). Code 29822, is not separately payable when another shoulder arthroscopy procedure is billed and paid on the same shoulder for the same day for the same beneficiary at the same encounter.
Affected Code(s)
29822, 29805, 29806, 29807, 29819, 29820, 29821, 29823, 29824, 29825, 29827, 29828


This is from NCCI manual

21. With limited exceptions, open or arthroscopic procedures performed on a joint include debridement (open or arthroscopic) if performed. A debridement code may be reported with a joint procedure code only if the debridement is performed on a different joint or at a site unrelated to the joint. See Section E (Arthroscopy) for discussion of exceptions.
-----Section E----
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 3 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 (Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure)), 29827 (Arthroscopy, shoulder, surgical; rotator cuff repair), and 29828 (Arthroscopy, shoulder, surgical; biceps tenodesis) may be reported separately with CPT code 29823 if the extensive debridement is performed in a different area of the same shoulder.
 

amyjph

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Munising, MI
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Read the NCCI manual Chapter IV Musculoskeletal, E. Arthroscopy. What diagnosis is appended to the 29822 if reported with 23412? Is it being assumed by the payer that it was a scope converted to open? Do you possibly need an X modifier on the 29822 and the correct diagnoses? I am not sure you can report 29822 with the open RCR codes anyway even with a modifier. I think the same concept would apply as doing another scope in the same shoulder regardless of if open or closed. Did you check the AAOS Global Service Data Guide?

Seems like the 29823 should be payable with RCR if done on three other discrete structures. What is the denial, bundling? If the diagnosis pointers are not attached properly that could be one problem.

Tough to say without seeing a report or specifics on denials.
 
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