# Subacromial Decompression & Debridement Bursal Side Shoulder



## dyoungberg (Mar 9, 2012)

Our doctor performed a diagnostic shoulder arthroscopy, subacromial decompression and limited debridement of bursal side rotator cuff.  Since 29826 is now an add on code and can't be billed separately, I am struggling with how to correctly code the procedure.  Does anyone have an idea of how I might code this procedure?

PREOP DIAGNOSIS:  ROTATOR CUFF TEAR LEFT SHOULDER  

POSTOP DIAGNOSIS: 
1. IMPINGEMENT LEFT SHOULDER   
2. PARTIAL THICKNESS BURSAL SURFACE ARTICULAR TEAR ROTATOR CUFF LEFT SHOULDER 

PROCEDURE:
1. DIAGNOSTIC ARTHROSCOPY LEFT SHOULDER 
2. ARTHROSCOPIC SUBACROMIAL DECOMPRESSION LEFT SHOULDER 
3. LIMITED DEBRIDEMENT OF BURSAL SURFACE ROTATOR CUFF TEAR LEFT SHOULDER 

ANESTHESIA:   GENERAL 

CLINICAL FINDINGS: The biceps labral complex was intact. The articular surfaces were intact. There was a full ROM. There was a type III acromion. There was perhaps a 10% thickness bursal surface tear as noted above.  

PROCEDURE: The patient was brought to the OR where general anesthesia was induced without incident. The patient was intubated without complication. He was placed in the beach chair position and bony prominences were well padded. EUA demonstrated a normal ROM of the shoulder. The lateral aspect of the shoulder was prepared with Betadine. The shoulder was insufflated with Lidocaine w/epi 1:100,000 and normal saline. The left shoulder and arm were prepped and draped free in the usual sterile manner. 

A standard diagnostic arthroscopy was performed introducing the scope into the posterior soft spot and advancing into the safe triangle. Wissinger rod technique was used to create an anterior portal and all intraarticular structures were evaluated and palpated. 

A suspicious area was marked with a suture. 

Instruments were redirected into the subdeltoid space where a decompression was performed in the manner described by Caspari, levering the bur off the undersurface of the scapular spine thus performing a partial anterolateral acromionectomy. The CA ligament was released with the tissue ablator. 

A careful debridement of the bursal surface tear was done and it was not substantial enough to repair. The shoulder was copiously irrigated and sucked dry. Arthroscopic instrumentation was removed. The wounds were closed with staples. The shoulder was insufflated with a mixture of Ropivacaine and MS. A sterile dressing was applied. 

The patient was extubated, transferred to the recovery room stretcher, and taken to recovery without incident. 

Thanks!


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## josephmglick (Mar 11, 2012)

This is a posting on Margie Scalley Vaught's website

Currently there is a CCI edit with 29822 and 29826 which I thought was probably an overlooked oversight so I sent a request to CCI for clarification and it appears CMS is sticking to the edit "Code 29822 is a component of Column 1 code 29826 but a modifier is allowed in order to differentiate between the services provided. "
So if the patient is a Medicare patient we are going to have to just bill 29822 - if the patient is private and follows CPT guidelines we can try to bill both, but they may require a modifier which per the CCI edit it means that the modifier goes on 29822.* You are either going to have to check with your private payers or report the two and see how they reply...
I got a reply from CCI and they stated after checking with CMS the edit stands. Here is the reply:

"The Centers for Medicare and Medicaid Services (CMS) owns the NCCI and Medically Unlikely Edit (MUE) programs and makes all decisions about their contents.

We discussed your concerns about this NCCI edit with CMS, which surfaced because of the new CPT instruction that was added to the 2012 CPT Manual under CPT code 29826 and the change in code descriptor for CPT code 29826 to make it an add-on code as of Jan 1, 2012.

The NCCI edit 29826/29822 was implemented on October 1, 2011 based on a longstanding CMS coding policy that does not allow separate reporting of debridement when performed at the same anatomic site as another reparative surgical procedure during the same patient encounter. Although the CPT Manual converted CPT code 29826 into an add-on code in 2012, CMS decided to retain the edit. The edit allows use of an appropriate NCCI-associated modifier when the two procedures are performed on contralateral shoulders."

Now my reply back was that I guess I do not understand as 29826 could never be a primary for a right shoulder and 29822 for the left shoulder...

Their reply: "The add-on code 29826 may be reported on a contralateral shoulder from 29822 if the contralateral shoulder also has a primary procedure performed for which 29826 is an appropriate add-on code. CMS does recognize 29826 as an add-on code but does not allow 29822 as a primary code in this case due to the code descriptor for procedure 29822. In a few instances, CMS does not follow the AMA’s CPT Manual guidelines for Medicare."

It appears to come down to - Even though CPT states you can report 29826 with 29822 - CMS is saying no. Similar to code 69990 where CPT gives a list of codes NOT to report it with, CMS has a longer more extensive list...


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