# 29824 and 29823



## Robbin109 (Apr 2, 2013)

Are debridement codes 29823 or 29822 included in the work of Claviculectomy, 29824

Thanks! 

 (new to orthopaedics)

Report:

75 year old man with chronic thickening of the subacromial bursa with swelling and not responsive to conservative care. It is felt he was a candidate for arthroscopic debridement.

An MRI study revealed severe rotator cuff tendinopathy, osteoarthritis of the glenohumeral joint and communication with the subacromial bursa.

Operative Procedure:

Standard arthroscopic portals were made and the arthroscope introduced in the posterior portal.

He was noted to have severe degenerative arthritis of the glenohumeral joint with eburnated bone on both glenoid and on the humerus.  Rotator cuff was retracted to the glenoid level.  Labrum was degenerative and frayed.  There was evidend of crystal synovitis with deposits in the soft tissue which appeared to be purophosphate deposits.

The distal clavicle was arthritic.  There appeared to be some capsular adhesions preventing communication with the subacromial bursa.

The acromion was noted also to be frayed and irregular on the under surface.

Through al lateral porta, a bur was inserted in addition to the shaver; debridement was performed with the shaver 4.5 aggressive. This was done thru an anterior portal.

The frayed unstable tissue was removed. 

Bursa was then entered,_____was entered. The shaver was introduced into the bursa and was debrided. The lining was removed.

Distal clavical was resected to allow for communication with the shoulder joint with the bursa, so large accumulations would not occur subcuteneously.

Following this, the shoulder was irrigated with copious amounst of irrigating solution. Rotator cuff did not appear to be repairable.   He will likely need a shoulder replacement, although pre-op his main concern was the large bursa on the top of this shoulder. Wounds left open for drainage. Maricaine and morphine injected into the shoulder and subacromial space.  

MD coded:

29824
29826
29823 ( included???)

Thanks for your help.


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## nyyankees (Apr 3, 2013)

Robbin109 said:


> Are debridement codes 29823 or 29822 included in the work of Claviculectomy, 29824
> 
> Thanks!
> 
> ...



I don't see the bone work for 29826. I would Q your doc. As for 29822 or 29823 looks like your doc did do a 29823 (Labrum + synovitis) but he is not clear in the note as to what he debrided. Go back and get clarification and update the note so you can capture 29823. Sometimes it's good to add size of bone resected for 29824. Most of my docs do that.


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## Robbin109 (Apr 3, 2013)

Thanks for your help. 

So in general, can 29823 be billed with 29824..It's not inclusive to this procedure?


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## nyyankees (Apr 3, 2013)

Robbin109 said:


> Thanks for your help.
> 
> So in general, can 29823 be billed with 29824..It's not inclusive to this procedure?



Yes as long as the debridment is unrelated to AC joint/area. You may need 59 mod to show separate area of shoulder but I don't think you do.


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