Wiki Shoulder Experts

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heatherweinmaster@gmail.com

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Calling all Orthopedic Shoulder Coding Experts:

With the new shoulder coding changes, is it still appropriate to bill Subacromial Decompressions with Distal Clavicle Excisions? Either 29826 with 29824 or 29826 with 23120.

It seems as though with the 29823 and 29822 becoming bundled with many other procedures that maybe these are too?

Thank you for your insight.
Heather
 
I've only been coding shoulder surgeries for a short time. I know I have a lot to learn, but I find it very interesting! I will only code 29826 if the physician performs SAD with Acromioplasty with one or more of the parent codes (29806-29828). I do code 29826 and 29824 together. 29826 is inclusive of 23120. There may be someone with more experience with a better answer :)
 
29826 with 29824

The CPT codes that may be reported in conjunction with code 29826 are 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29827, and 29828.
 
I need help with 29826

Our contract with IBC does not cover 29826 can anyone see what else I can code here instead of that

PREOPERATIVE DIAGNOSIS: Superior labral tear of the left shoulder.

POSTOPERATIVE DIAGNOSES: Subacromial impingement with bursitis of the left shoulder.

PROCEDURES PERFORMED:
1.Surgical arthroscopy of the left shoulder with subacromial decompression.
2.Bursectomy.

ANESTHESIA: Interscalene block and general.

ESTIMATED BLOOD LOSS: Minimal.

COMPLICATIONS: None.

OPERATIVE INDICATIONS: The patient is a 45-year-old female with several month history of left shoulder pain after fall at home. She had an MRI of the shoulder which showed the correction of the superior labral tear. She failed nonoperative treatments including anti-inflammatory medication and intraarticular corticosteroid injections. Intraoperatively, there was evidence of sublabral foramen, but no evidence of superior labral tear. There was no evidence of rotator cuff. There was evidence of subacromial impingement and subacromial bursitis.




DESCRIPTION OF PROCEDURE: The patient was taken to the operating room. The patient was escorted to the operating room, and placed supine on the operating room table. After adequate induction of interscalene and general anesthesia, the left upper extremity was prepped and draped after positioning the patient in beach-chair position. All bony prominences were well-padded. The left upper extremity was prepped and draped in usual sterile fashion. A time-out was performed. Arthroscopic portal sites were infiltrated with 1% lidocaine with epinephrine. A #11 blade was used to establish a posterior portal. The arthroscope was introduced in the glenohumeral joint. The glenohumeral joint showed normal articular cartilage. The biceps tendon was intact. Anterior portal was established with a #11 blade followed by cannula. A probe was introduced. The biceps tendon was probed and found to be firmly attached to the superior labrum. There was no evidence of superior labral tear. There was evidence of sublabral foramen. The rotator cuff was evaluated and was intact without evidence of full-thickness or partial tear. At this time, the arthroscopic instruments were then placed in a subacromial space. A lateral subacromial portal was established. A #11 blade was used to establish the lateral portal. The arthroscopic shaver was introduced. There was marked subacromial bursitis and evidence of subacromial impingement. A subacromial bursectomy was performed with a shaver and an ArthroCare wand. The rotator cuff was visualized from above and found to be intact. An acromioplasty was performed with an oval bur. After adequate acromioplasty and bursectomy was performed, the arm was brought through range of motion there was found no further evidence of impingement. At this time, the shoulder was copiously irrigated. The portals were closed with 3-0 nylon suture in a horizontal fashion. Dressings were Xeroform, 4x4's and Tegaderm. The patient was then placed in a sling and brought to the PACU in stable condition.

All sponge and needle counts were correct on two occasions.
 
Debridement codes 29822, 29823

Due to the changes made to the NCCI Surgical Policy manual this year code 29822 cannot be billed with any other arthroscopic shoulder code.

Code 29823 can only be billed with 29824, 29827 & 29828.
 
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