Orthopedic Coding Alert
Know Purpose of Shoulder Arthroscopy Before Coding
Question: Encounter notes indicate that the provider performed a level-four office evaluation and management (E/M) service for a new patient, and then performed a shoulder arthroscopy. What are the correct codes for this encounter? Louisiana Subscriber Answer: The E/M coding is straightforward. The shoulder arthroscopy, not so much. For the E/M, you’ll report 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/ or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter.) with modifier 57 (Decision for surgery) appended to show that the E/M led to the decision for surgery. All of the shoulder arthroscopy codes have a major (90-day) global period, meaning you won’t have a need for modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) on this claim. Remember, modifier 25 is for E/Ms that precede procedures with a minor (0- or 10-day) global period. If the shoulder arthroscopy is diagnostic, you’ll report 29805 (Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure)). If the shoulder arthroscopy is surgical, things get tricker. You’ll either choose a code from 29806 (Arthroscopy, shoulder, surgical; capsulorrhaphy) through 29825 (… with lysis and resection of adhesions, with or without manipulation); or you’ll report 29827 (Arthroscopy, shoulder, surgical; with rotator cuff repair) or 29828 (… biceps tenodesis). So if the notes indicate that the provider performed a shoulder arthroscopy with superior labrum from anterior to posterior (SLAP) lesion repair, you’d report 29807 (… repair of SLAP lesion). Add-on reminder: If — in addition to the shoulder arthroscopy — the provider performs decompression of subacromial space with arch release, report +29826 (Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (List separately in addition to code for primary procedure)). This is an add-on code, meaning you can only report it in conjunction with another code that CPT® allows. For example, CPT® states “Use +29826 in conjunction with 29806-29825, 29827, 29828.” Modifier reminder: Once you decide on the coding for this encounter, be sure to check the notes for laterality. Then, append either modifier LT (Left side) or RT (Right side) to each of the shoulder arthroscopy codes you report.
Related Articles
Orthopedic Coding Alert
- Medicare Final Rule:
MPFS Conversion Factor a Tough Pill for 2023
Unless Congress acts, CF will be significantly cut. The Centers for Medicare & Medicaid Services [...] - E/M 2023:
Extend Prolonged Service Smarts With New Codes
CMS and CPT® still at odds over when to add extra time. The Centers for [...] - Clip & Save:
Consult This Chart to Select Codes
To avoid confusion over code choice for your Medicare and private payer patients, and to [...] - Injections:
Count This Instead of Shots for Accurate TPI Tally
Here’s why the number of overall shots is irrelevant to your code choice. When a [...] - You Be the Coder:
Allergic Arthritis Dx Nothing to Sneeze At
Question: Encounter notes indicate that a patient suffered from “allergic arthritis, R ankle.” Is this a [...] - Reader Questions:
Know Purpose of Shoulder Arthroscopy Before Coding
Question: Encounter notes indicate that the provider performed a level-four office evaluation and management (E/M) service [...] - Reader Questions:
Get Off on Right Foot With F/T Modifier Coding
Question: I’m relatively new to orthopedic coding, so a couple of the modifiers I’m familiarizing myself [...]
