Orthopedic Coding Alert

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 like an ace.

According to an April 2004 bulletin from the American Academy of Orthopaedic Surgeons (AAOS), reporting 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 is one of the most common coding errors. 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.

You-ll always report 29807 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 orthopaedic 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.

Code 29806 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 says, 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."

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 say, but physicians usually accomplish it by repairing parts of the capsule (hence the name "capsulorrhaphy").

Another term you might see for this repair is "rotator interval closure." "The rotator interval is the ligamentous space between the anterior edge of the supraspinatus and the superior edge of the subscapularis," Mallon says. "This is often tightened up in an arthroscopic Bankart. Another term to look for might be -capsular shift,- which is a variant of a Bankart but can be done arthroscopically and often is.-Finally, you might also look for a description of tightening the IGHL (inferior gleno-humeral ligament)."

Once you-ve got the lingo down regarding which code applies to which surgery, you still need to know when you can ethically report 29806 and 29807 together.

Here's the problem: The physician may perform both a SLAP lesion repair and a Bankart repair during the same session, but that doesn't mean you can report both 29806 and 29807.

"When the operative report indicates that more than one capsular lesion was repaired, the key is determining the location of each repair," Stout says.

"Remember, CCI [Correct Coding Initiative] bundles 29807 into 29806," Stout says, "so it is not appropriate to report both codes unless the capsular defect is in a different area than the SLAP lesion."

For example: "According to the AAPC's Orthopedic Specialty Credential Study Guide, some insurers allow you to report 29806 and 29807-59 (Distinct procedural service) if the surgeon repairs both the capsular ligament (such as the glenohumeral ligament) and the labrum, as long as separate sutures are used," says Angela Clements, CPC, CCAT, CPAT, an abstractor at Ochsner Health System in Covington, La.

Because insurers have identified misuse of modifier 59 with this code pair as a common coding error, you may benefit by submitting your documentation with your claims if you-re billing 29806 and 29807-59 together on the same claim.