Orthopedic Coding Alert

• Humeral bone, humeral articular cartilage
• Glenoid bone, bone articular cartilage
• Superior labrum, biceps anchor, biceps tendon
• Anterior, inferior, posterior labrum
• Capsule (including glenohumeral ligaments)
• Rotator cuff (bursal, articular, subacromial bursa)

Examples of extensive debridement include:

• Chondroplasty and a debridement of the labrum (a combination of hard and soft structures).
• An abrasion arthroplasty (microfracturing/drilling down to bleeding bone) and a biceps tenotomy (a combination of hard and soft structures).
• Debridement of a biceps tendon and a partial thickness rotator cuff tear (multiple soft structures).

Limited example: Notes indicate that the surgeon performed debridement on the right biceps anchor and the inferior labrum. On the claim, you’d report 29822 with modifier RT (Right side) appended to indicate laterality, if the payer requires it.

Extensive example: Notes indicate that the surgeon performed debridement on the right biceps anchor, inferior labrum, rotator cuff, and glenoid bone. On the claim, you’d report 29823 with modifier RT appended to indicate laterality, if the payer requires it.

Keep NCCI in Mind

You’ll need to be aware of National Correct Coding Initiative (NCCI) restrictions on reporting 29822 and 29823 along with other arthroscopic shoulder procedures. “CMS considers the shoulder to be a single anatomic structure. With three exceptions an NCCI procedure to procedure modifiers when the two procedures are performed on edit code pair consisting of two codes describing two shoulder arthroscopy procedures should never be bypassed with an NCCI-based modifier for the ipsilateral shoulder.”

NCCI further states that “CMS considers the shoulder to be a single anatomic structure. With three exceptions, an NCCI procedure to procedure edit code pair consisting of two codes describing two shoulder procedures shall not be bypassed with an NCCI-associated modifier when performed on the ipsilateral shoulder.”

Takeaway: All shoulder arthroscopy codes include limited debridement, so you shouldn’t be reporting 29822 with any other shoulder arthroscopy codes for the same anatomical area. With three exceptions, shoulder arthroscopy procedures also include extensive debridement even if the extensive debridement is performed in a different area of the same shoulder than the other procedure. The trio of exceptions are:

• 29824 (… distal claviculectomy including distal articular surface (Mumford procedure))
• 29827 (… with rotator cuff repair)
• 29828 (… biceps tenodesis)

If the extensive debridement is performed in a different area of the same shoulder during the above surgical procedures, it might be separately reportable with 29823, Felt says. If you do report an extensive debridement along with one of the codes above, be sure to append modifier 59 (Distinct procedural service) to 29823 to show that it was a separate procedure from the initial arthroscopy.

Example: Notes indicate that the surgeon performed left shoulder arthroscopy with rotator cuff repair. During the surgery, they also debrided the glenoid bone; superior labrum; inferior and posterior labrum; glenohumeral ligaments; and the rotator cuff.

For this encounter, you’d report 29827 as the primary procedure code, followed by 29823 with modifier 59 appended. Don’t forget to append modifier LT (Left side) to 29827 and 29823 to indicate laterality, if the payer requires it.

One more thing: For the above example, if the payer requires the X modifiers, you’ll choose XS (Separate structure) instead of modifier 59 for 29823.