Coding Arthroscopic Subacromial Decompression
Hi fellow coders!!!
My doctors will not accept the fact that they cannot use 29826 as a stand alone.
I am wondering how people are coding opnotes such as the one below. In this case he also does a manipulation.
I would really like to know what everyone is using for29826 when that is all they do.
Thank you so much!!!
1. Right shoulder pain.
2. Right shoulder secondary frozen shoulder.
3. Right shoulder bursitis.
1. Right shoulder arthroscopy.
2. Right shoulder manipulation under anesthesia, an examination under
3. Right shoulder arthroscopy with subacromial decompression.
WHAT WAS DONE: The patient was brought to the preoperative area, site and
side were identified. Interscalene block was administered. He was then
brought in to the operating room and placed supine on the operating room
table. Bony prominences were padded appropriately. General endotracheal
intubation was performed. He was placed in the beachchair position.
Examination of right shoulder under anesthesia. He had passive range of
motion to approximately 90 to 100 degrees, abduction to 90 to 100 degrees.
He had decreased external rotation. Manipulation under anesthesia was
performed. Audible and palpable lysis of adhesions was appreciated. The
patient had full passive range of motion in both forward flexion and
abduction planes post-manipulation, was able to be placed in the abducted
and externally rotated position. Right upper extremity was then prepped
and draped in sterile fashion. Bony landmarks of shoulder including
posterolateral, lateral and anterolateral aspect of the acromion were
marked with a marking pen, coracoid process and AC joint was marked as
well. Then, a mark was made 2 fingers down, 2 fingers medial from the
posterolateral aspect of the acromion. An 18-gauge spinal needle was
inserted into the glenohumeral joint. Joint was distended with 60 mL of
sterile saline. An #11 blade scalpel was used to incise the skin.
Arthroscope was introduced in the posterior aspect of glenohumeral joint
and a diagnostic arthroscopy was begun. There was no evidence of
chondromalacia over the glenoid or humeral surfaces. There was evidence of
erythema involving the capsule. There was no evidence of superior labral
tear. Subscapularis muscle was in good condition. Biceps tendon was in
good condition. The rotator cuff was inspected, supraspinatus,
infraspinatus tears minor, tendon showed no evidence of articular-sided
tearing. There was no evidence of loose bodies in the axillary pouch. No
evidence of posterior or inferior labral tear. Once all intraarticular
work was complete, arthroscope was introduced in subacromial space. There
was evidence of abundant bursitis. A lateral portal was established 3
fingers down from the anterolateral aspect of the acromion. A 7-0 cannula
from Arthrex introduced into the space. A complete bursectomy was
performed. The rotator cuff was inspected from the bursal side, both
internal and external rotation. There was no evidence of rotator cuff
tear. The undersurface of the acromion was cleared of all soft tissue.
Coracoacromial ligament was released from a lateral portal using a 4-0
acromionizer bur, a subacromial decompression was performed. Once
decompression was complete, all arthroscopic instrumentation was removed
from the shoulder, 3-0 Prolene in interrupted fashion used to approximate
skin edges. Sterile dressings applied, sling was applied. The patient was
awoke from general endotracheal intubation and brought to PACU in stable
condition. He tolerated procedure well. Dr. Christiano was present
throughout the entire procedure. The patient received 1 g of vancomycin as
IV antibiotic prophylaxis.
The AAOS advised us to use the debridement codes 29822 or 29823 depending on how the Op Report reads. Here is an article that directly quotes the AAOS on this issue.
As of January 2012, AMA states, “CPT code 29822, Arthroscopy, shoulder, surgical; debridement, limited, or CPT code 29823, Arthroscopy, shoulder, surgical; debridement, extensive, would be reported as appropriate, when an arthroscopic subacromial decompression is the only procedure performed.”