Orthopedic Coding Alert

Question: Our surgeon did a superior labral repair with a separate posterior labral repair. The surgeon reported 29807 (Arthroscopy, shoulder, surgical; repair of SLAP lesion) and 29806 (Arthroscopy, shoulder, surgical; capsulorrhaphy). We are not sure if we can report both codes with a 59 (Distinct procedural service) modifier or do we report code 29807 only. Please clarify.

Ohio Subscriber

Answer: You may report both 29806 and 29807 when you have sufficient documentation. CCI bundles a SLAP repair with a Bankart repair According to CCI, Code 29807 is a column 2 code for 29806, but a modifier is allowed in order to differentiate between the services provided. You append modifier 59 to 29807 when the surgeon’s documentation supports two separate, distinct procedures.

Surgeons must be very specific in describing the location of the various repairs to support separate reporting. If the capsular repair and SLAP repairs overlap, payers generally will not reimburse to both. Even in case where separate repair are clearly described (i.e, SLAP repair and anterior-inferior capsular shift) getting both codes paid can be a battle.

You need to note that CPT^® does not include a specific arthroscopic code for an inferior labral injury. You report code 29806 for capsulorrhaphy. If your surgeon completes the capsulorraphy only with labral repair and tightening up the antero-inferior glenohumeral ligament, you cannot report code other than 29806. You submit code 29807 for labral repair if the surgeon documents that the labral injury extended into the anterosuperior quadrant of the gleno-humeral joint. You may report these codes together though your surgeon clearly needs to document that these were separate and distinct procedures. Your surgeon should document that capsulorraphy and labral repair were completed separately and in different sections of the joint (usually one superior and one inferior).

Bankart lesion: A Bankart lesion occurs in recurrent shoulder dislocations, 718.31 (Recurrent dislocation of joint; shoulder region). This occurs when the patient tears the labrum at its attachment to the inferior glenohumeral ligament.