# 29823 vs. 29805 & 29999



## jenpollock (Apr 7, 2011)

Any help would be greatly appreciated!! Dr performed Arthroscopy and washout, right shoulder joint and subacromial space.  

We have two different opinions on how to bill for this case:

29823    or   29805 & 29999

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PROCEDURE PERFORMED:	
Arthroscopy and washout, right shoulder joint and subacromial space.

SURGEON:	 MD

ASSISTANT:	None

ANESTHESIA:	General by Dr. X. The patient tolerated the procedure well.

ESTIMATED BLOOD LOSS:	Minimal.

SPECIMENS:	None.

COMPLICATIONS:	None.

INDICATION FOR THE PROCEDURE:	


PROCEDURE IN DETAIL: The patient was brought to the operating room and properly identified. He was given 1g of IV vancomycin for infection. His cultures prior to the surgery where growing Staphylococcus epidermidis Staphylococcus Staphylococcus lugdunensis, both sensitive to vancomycin. The patient was given a general anesthesia by Dr. Wong and then was put in the left lateral decubitus position on the beanbag. The right shoulder was sterilely prepped and draped from the neck to the hand and was held in a sterile arm holder with 10 pounds traction. Arthroscopy was performed through the previous posterior and anterior portal incisions. Rotary shaver was inserted through the anterior incision and debridement and washout of the subacromial space was performed first. The rotator cuff did not show any evidence of tears. The shoulder joint was then entered from posteriorly and the anterior trocar was then inserted into the joint to allow washout of the joint. This was performed after washout of the subacromial space, as the subacromial space was felt to be likely the infected area. The joint was washed out thoroughly. The instruments were removed and closure was performed using interrupted 4-0 nylon suture and anterior and posterior portal incision. The accessory anterolateral incision, which was draining was not closed. The patient was then dressed with sterile dressings and was awakened and taken to the postanesthesia care unit in a stable condition.
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Thanks for the help!!


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## jessicajones1081 (Apr 7, 2011)

As with all arthroscopic procedures, code 29805 (Arthroscopy, shoulder, diagnostic with or without synovial biopsy) is reported only when nothing else is done. If any other code is used, it is not appropriate to report the diagnostic code. Since you have debridement, you would not code the 29805.  Debridement is to be reserved for situations in which *articular cartilage *is debrided For extensive debridement (29823), the documentation should support work in BOTH the front and back of the shoulder. 

Hope this helps.


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## maryanneheath (Apr 7, 2011)

jenpollock said:


> Any help would be greatly appreciated!! Dr performed Arthroscopy and washout, right shoulder joint and subacromial space.
> 
> We have two different opinions on how to bill for this case:
> 
> ...




I agree with Jessica above, it would be inappropriate to use 29805 in this situation.  I always tell my coworkers, that is a Lookie-Lou code ONLY and is not used with anything else.  I would bill this as 29823.  Hope this helps!


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## jenpollock (Apr 7, 2011)

Thank you both very much!! That's what I thought


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