Identify Key Differences When Billing SLAP Repairs

Differentiate between 29806 and 29807 and you’ll find the right code
Don’t let SLAP lesion repairs trip up your coding accuracy. As long as you know the bundling rules and the shoulder anatomy specs, you’ll code these claims without breaking a sweat.
According to an April 2004 bulletin from the American Academy of Orthopaedic Surgeons (AAOS), one of the most common coding errors is to report both 29807 (Arthroscopy, shoulder, surgical; repair of SLAP lesion) and 29806 (Arthroscopy, shoulder, surgical; capsulorrhaphy) for repair of a SLAP lesion without a capsular defect in an area different from the SLAP. But even coders who know the rules can get confused when coding SLAP lesion claims because the code descriptors for these procedures don’t match the clinical language that the surgeon uses.

Look to 29807 for SLAP Repair

You’ll always report 29807 (APC 0042) when the physician repairs a SLAP lesion, which is a "tear of the antero-superior (usually) or postero-superior glenoid labrum," says Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C. If you aren’t sure whether the physician performed a SLAP repair, look for keywords in the documentation such as "SLAP" or "antero-superior glenoid labrum," he says.
Your surgeon may also describe a "superior labral tear between 10 o’clock and 2 o’clock," which may also warrant using 29807, says Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network LLC. In this scenario, confirm with the physician that his documentation is, in fact, describing a SLAP lesion repair, Stout says.

Consider 29806 for Bankart

Code 29806 (APC 0042) describes the physician’s work repairing an unstable shoulder, Mallon says.
"Keywords to look for are ‘recurrent instability’ or ‘recurrent dislocations,’ " he says. "The surgery, however, is not exactly a capsulorrhaphy," Mallon adds, so you may not see the word "capsulorrhaphy" in the documentation, even if the physician performed a procedure described by 29806.
"You should also look for the word ‘Bankart,’ which is the eponym for the former open procedure we usually did for unstable shoulders," Mallon says. "It is now usually called an arthroscopic Bankart."

Scan the Documentation

You should also scan the documentation for the phrase "Bankart lesion," which signals that the physician performed the work described by 29806.
"This is a lesion of the antero-inferior glenoid labrum (from 3 to 6 o’clock) on the clockface," Mallon says. The arthroscopic Bankart is actually also a labrum repair, he says, but physicians usually accomplish it by repairing parts of the capsule (hence the name "capsulorrhaphy").
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- Published on 2008-01-15