Orthopedic Coding Alert

Some require debridement; others call for surgery past debridement.

Attendees to HEALTHCON 2023 got a master class in all things arthroscopic from Jessyka Burke, BHSA, CPC, COSC, CASCC. During her presentation “Unraveling the Complexities of Arthroscopic Procedures of the Shoulder, Hip, and Knee,” Burke ran through scope procedures for shoulders and more.

Check out this primer on coding repairs for labral tears and lesions, and a couple of other shoulder scope surgeries aimed at getting your patient on the road to recovery.

Opt for This Code Pair for SLAP, Bankart Lesions

Tears — which are also referred to as lesions in these injuries — in the labrum will often prompt your surgeon to opt for an arthroscopic procedure. These codes could mark a debridement or surgical repair beyond debridement.

SLAP lesion: SLAP — or superior labrum anterior to posterior — lesions involve a tear on the superior labrum with involvement of the biceps tendon anchor site on the labrum. Report surgical repair of SLAP lesions with 29807 (Arthroscopy, shoulder, surgical; repair of SLAP lesion).

Bankart lesion: These lesions involve a tear in the lower rim of the labrum. Repairs are coded with 29806 (… capsulorrhaphy). Capsulorrhaphy procedures are done to treat shoulder instability typically caused by a defective or loose capsule.

Example: In the hospital setting, the orthopedist sees a patient with a right shoulder injury. After ordering a complete shoulder X-ray to rule out fracture and magnetic resonance imaging (MRI) with contrast material to pinpoint the location of the injury, the surgeon identifies a SLAP lesion in the patient’s right shoulder. They then repair the defect.

On the claim, you’d report:

• 29807 for the surgery
• 73222 for the MRI
• 73030 for the X-ray
• Modifier RT (Right side) appended to 29807, 73222, and 73030 to indicate laterality
• Modifier 26 appended to 29807, 73222, and 73030 to indicate that you are only billing for the professional component of these codes, not the technical component (since the hospital owns the X-ray/MRI equipment)
• S43.431A (Superior glenoid labrum lesion of right shoulder, initial encounter) appended to 29807, 73222, and 73030 to represent the patient’s SLAP lesion

Know SLAP Lesion Types

If the patient suffers from a SLAP lesion, there are four distinct types: I, II, III, and IV. Each tear has its own characteristics, and there are different coding routes for repair of each type of tear.

Type I: A type I SLAP lesion is “frayed and degenerative, but remains intact to the glenoid; biceps anchor is also intact,” explained Burke. Type I tears require debridement to repair, which you’d report with 29822 (Arthroscopy, shoulder, surgical; debridement, limited, 1 or 2 discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body[ies])) or 29823 (… debridement, extensive, 3 or more discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body[ies])).

Discrete structures, as described in codes 29822 and 29823, are:

• Humeral bone/articular cartilage
• Glenoid bone/articular cartilage
• Biceps tendon
• Biceps anchor complex
• Articular capsule
• Subacromial bursa
• Rotator cuff
  • Bursal
  • Articular
• Labrum
  • Superior
  • Anterior
  • Inferior
  • Posterior

Type II: Type II SLAP lesions involve “detachment of labrum and biceps anchor from superior glenoid,” said Burke. Type II tears require surgical repair beyond debridement, which you’d report with 29807.

Type III: Type III SLAP lesions involve the “labrum torn away, but biceps anchor and remaining labrum are still attached to glenoid,” Burke explained. Type III repairs could require debridement only or surgical repair beyond debridement, which you’d report with 29822/29823 or 29807, respectively.

Type IV: Type IV SLAP lesions involve a “bucket handle tear of labrum that extends into biceps anchor,” according to Burke. Type IV tears require surgical repair beyond debridement, which you’d report with 29807.

Example: In the hospital setting, the orthopedist sees a patient with a left shoulder injury. After ordering a complete shoulder X-ray to rule out fracture and magnetic resonance imaging (MRI) with contrast material to pinpoint the location of the injury, the surgeon identifies a type I SLAP lesion to the left labrum. They then repair the tear, which involves one discrete structure in the shoulder. On the claim, you’d report: