# Reoccurring shoulder question regarding 29826, 29824, and 29823



## jenarnold (Oct 19, 2011)

My questions after hours of research are:

Should 29823 be coded? NCCI states that 29823 can be separately reported with 29824. My op report does not specify “extensive” debridement. The debridement was completed on the glenohumeral labrum and undersurface of the rotator cuff through a separate approach from the other repairs. The provider can only report 29826 when 29827 is completed as well. So, because the surgeon performed 29824 through one portal and did the debridement 29823 in the glenohumeral joint through a separate portal he can bill separately for both? Is this correct? Does it matter that debridement, per NCCI edits, is included for both 29826 and 29827? Thanks!
Here is my OP report:

The arthroscope was placed in the glenohumeral joint through a posterior portal. Upon entering glenohumeral joint we were able to visualize the articular surfaces. There was no evidence of significant articular disease. The biceps tendon was intact along the entire course including the anchor. The glenohumeral labrum exhibited mild fraying around its entire course. The undersurface of the rotator cuff exhibited undersurface fraying of the supraspinatus tendon consistent with a partial-thickness rotator cuff tear. This involved no greater than 20% of the tendinous thickness. There was no evidence of high-grade partial-thickness or full-thickness disruption. The capsular structures were well defined and attached to the glenoid rim. 
At this point a supplemental anterior portal was created. Through this portal a 4.5 full-radius resector was introduced and debridement was performed on the glenohumeral labrum and undersurface of the rotator cuff. These structures were debrided to a stable and viable margin.

After performing the work within the glenohumeral joint, we then proceeded with subacromial arthroscopy. The arthroscope was place in the subacromial space through a posterolateral portal, supplemental inflow cannula posteriorly and instruments through an anterolateral portal. Upon entering the subacromial space our visualization was precluded by dense and prolific bursal tissue. A complete bursectomy was performed. At this point we were able to visualize the superior surface of the rotator cuff and the undersurface of the acromion. The superior surface of the rotator cuff exhibited no evidence of disruption. The undersurface of the acromion was noted to exhibit a prominent anterior acromial spur along with significant hypertrophy of the coracoacromial ligament. Arthroscopic subacromial decompression was performed with the use of a motorized resecting device. This decompression included the medial acromial facet. The distal clavicle was visualized. There were significant degenerative changes along with inferior osteophytes. Arthroscopic Mumford procedure was performed with the assistance of an anterior portal. Approximately one cm of distal clavicle was excised.


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## aclements (Oct 19, 2011)

Below is information from AAOS regarding 29823. I hope this helps you.

The AAOS Coding, Coverage and Reimbursement Committee recognizes three “areas” or “regions” of the shoulder: the glenohumeral joint, the acromioclavicular joint and the subacromial bursal space. These “areas” are clearly separate; procedures done in one area should not influence coding in a different area.
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.
Angie


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## jdemar (Oct 20, 2011)

I woudl and do bill 29822-59 for the labrum debridement of the  GH joint, if debridement was done but not extensive.  As mentioned in previous response the debridement of bone/osteophytes and soft tissue, etc....is for the extensive=29823.


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