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shoulder coding

  1. #1
    Location
    Columbus, OH
    Posts
    76
    Default shoulder coding
    Medical Coding Books
    I have a claim with a denial for 29823 (debridement) to 29824 per CCI. My understanding is that if the procedure is performed in another region (glenohumeral vs AC) it is billable. My confusion comes in when there's debridement performed in all 3 regions. Can I bill for the region that doesn't have an edit or since it's done in all 3 I can't?

    For example, I have the following:

    glenohumeral:
    29823-59
    29828-51
    29825 (bundled not billing)
    23700 (bundled not billing)
    subacromial:
    29826-51
    29823 (bundled not billing)
    AC:
    29824-51
    29827
    29823 (bundled not billing)

    Can I bill for the debridement (29823) in the glenohumeral joint?

    Kathy Daniel, CPC, COSC

  2. #2
    Location
    Columbus, OH
    Posts
    76
    Default
    I really need help with figuring this one out. Since the AAOS states there are 3 regions of the shoulder (glenohumeral, AC and subacromial) and procedures done in one area don't influence coding in a different area, can you bill for debridement in say the gleohumeral joint when a bundled code was performed in the AC joint? Making the issue more confusing is that debridement was done in each region so can you bill for the debridement in the region that does not have a cci bundled code? In the message first posted, I showed how the surgery was coded. 29823 was in each area and there were bundling issues in 2 of them, but not the 3rd. Can I bill for 29823 for the 3rd area?

    When coding shoulder procedures, I usually code each "region" as an individual procedure and then add modifier 59 when there is a cci edit with one of the other regions. Do any of you have a better way of coding the shoulder?
    Kathy Daniel, CPC, COSC

  3. Default
    Yes, I would bill for the 29823 also. I would bill it exactly how you billed it so I am not sure why they are denying. I would send in documentation showing the shoulder anatomy and the op note and a letter stating why you coded it this way.

  4. #4
    Location
    Columbus, OH
    Posts
    76
    Default
    Okay, I don't know why but shoulder coding drives me crazier than spine coding!! The more I look into the debridement issue the more confused I get. Is the debridement able to be separated by the "regions" or do you have to look at the whole shoulder to decide whether it is 29822 vs 29823? If you have to look at the whole shoulder, then you wouldn't be able to break down the different regions and if there were any bundling issues in any of the regions it would not allow you to report 29822 or 29823 at all... As you can tell I'm CONFUSED!!! I'm not sure I'm making any sense but any guidance would be appreciated!
    Kathy Daniel, CPC, COSC

  5. Default
    This is what I have on my wall:
    29822: For minor debridement of soft tissue, including labral debridement, cuff debridement, and so on.

    29823: Either for debridement of multiple soft tissue structures (labrum, subscapularis, supraspinatus) and/or chondroplasty of the humeral head or glenoid.

    This has helped me alot.
    Hope this helps you.

  6. #6
    Location
    Columbus, OH
    Posts
    76
    Default
    I also got some good advice from Margie Scalley Vaught: You can report a debridement code with modifier 59 if you debrided something that you did not go on to repair.

    She also mentioned using the same information you stated in your last post in regards to choosing which type of debridment to bill.

    I think I've finally got it! YEAH!!!

    I really appreciate your responses!
    Kathy Daniel, CPC, COSC

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