Orthopedic Coding Alert

Question: The physician’s notes state, “Bursal side rotator cuff showed fraying diffusely, was debrided to no more than 15% thick, over the size of a half dollar.” Does the service constitute limited or extensive debridement?

Colorado Subscriber

Answer: The current AMA guidance places the onus on the surgeon to state whether the debridement was limited or extensive, so your physician needs to specify this.

Difference: Code 29822 (Arthroscopy, shoulder, surgical; debridement, limited) covers limited debridement of soft or hard tissue, and you can use this code for limited labral or cuff debridement or removal of degenerative cartilage and osteophytes. Code 29823 (... debridement, extensive), by contrast, represents extensive debridement of soft or hard tissue.

According to The American Academy of Orthopedic Surgeons (AAOS) policy statements, limited debridement occurs when the surgeon completes the procedure in only one half of the gleno-humeral joint. Extensive debridement refers to debridement in both the anterior and posterior aspects of the gleno-humeral joint. Technically, in order to be extensive, it has to occur in the anterior and posterior portions of the GH joint.

However, given your example, you should consider this case to be limited debridement (29822).