# Shoulder help!



## lorilynn222 (Nov 18, 2010)

Physician performed the following. I am new to ASC and shoulder billing. Please help. I have 29823, 29824, 29826. Would 29823 or 29826 need a 59 mod? Thanks for any and all help.
Side: Right
Shoulder arthroscopy with ext debridement (29823)
Shoulder a/s w/ distal claviculectomy (29824)
Shoulder arthroscopy w/ acromioplasty (29826)
Operative
A diagnostic arthroscopy of the glenohumeral joint and subacromial bursa was then performed. The following findings were noted:
Glenohumeral synovitis
Type I SLAP lesion
Thick, hypertrophic subacromial bursitis
Medial acromial spur
AC joint hypertrophy
Partial thickness supraspinatus tear

An extensive debridement of the intra-articular debris was then performed. Any synovitis, fraying of the labrum and biceps tendon, and rotator cuff fraying found was debrided.

The arthroscope was directed to the subacromial space. Hypertrophic bursitis was noted. Impingement from the anterior and lateral acromion was noted on the rotator cuff. A radical bursectomy was performed using the arthroscopic shaver and the electrocautery wand. The undersurface of the acromion was debrided and the periosteum removed. Using the arthroscopic bur an anterolateral acrmioplasty was performed, decompressing the subacromial space.  Care was taken to remove all downward facing osteophytes including medial osteophytes near the acromioclavicular joint.  The coracoacromial ligament was released.

The arthroscope was then directed to the acromioclavicular joint. It was noted to be hypertrophic and impinging on the musculotendinous junction of the rotator cuff. Using the arthroscopic shaver and the electrocautery wand, the acromioclavicular joint capsule was removed exposing the distal clavicle. The arthroscopic bur was then used to remove approximately 6 or 7 mm of the distal clavicle. In addition, the acromial side of the a.c. joint was smoothed. Finally, the inferior surface of the distal clavicle was co-planed to prevent any further impingement.


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## coderguy1939 (Nov 22, 2010)

29823 requires a modifier when coded with 29824.  You may want to find out if your practice has a consistent policy on how much of the distal clavicle must be resected before coding the Mumford.  I've seen it range from 6 to 7mm, 8 to 10mm and all the way up to 15mm depending on the orthopedic journal you're reading.


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## bethh05 (Nov 23, 2010)

In order to code 29823 the debridment needs to be in the anterior and posterior shoulder, unless the physician dictates the debridment was extensive. As for 29824 guidelines state that the entire distal clavicle (approx. 1 cm) is excised. If you look up the AAOS website, they have some articles regarding coding shoulders. Good luck!


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## coderguy1939 (Nov 24, 2010)

AAOS is one source for determining the amount of distal clavicle that needs to be resected for 29824.  However, there are several others that differ from AAOS.  That's why I suggested settling on a particular source for your practice policy.


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