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:
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.
Amy P. CPC, CPB, COSC, CSFAC