Orthopedic Coding Alert

Question:Our surgeon did the following operative procedures:

1. Arthroscopic subacromial decompression with anterior acriomioplasty

2. Arthroscopic glenohumeral capsular release, right shoulder

The diagnosis (pre-operative and post-operative) is as follows:

1. Right shoulder impingement syndrome 

2. Right frozen shoulder

The procedure note read as follows:

"A routine posterior arthroscopic portal was established 3 cm inferior and 2 cm medial to the posterolateral corner of the acromion. The arthroscope was introduced into the glenohumeral joint and the surgical findings noted as above.

An anterior portal was established midway between the coracoid process and the anterolateral corner of the acromion. Through this portal, electrocautery was used to perform a complete synovectomy within the joint and in order to perform a posterior synovectomy, the arthroscope was introduced into the anterior portal and the electrocautery introduced into the posterior portal, thereby gaining access to perform a posterior synovectomy.

With the arthroscope in the posterior portal, arthroscopic biters and electrocautery were used to perform a complete capsular release and resection off the labral attachment. An arthroscopic elevator was used to detach the capsule from the inferior portion of the glenoid to the posterior margin of the glenoid capsule, thereby performing a circumferential capsular release. At the conclusion of the arthroscopic release, the instruments were removed from the portals and a manipulation under anesthesia confirmed that full range of motion had been achieved.

The arthroscope was removed from the glenohumeral joint, and via the posterior portal introduced into this subacromial space with care taken to be certain that the arthroscope was superior to the rotator cuff tendon. A lateral portal was then established 3 cm lateral to the mid-acromion, and through this portal a synovial resector was used to perform a complete bursectomy. Electrocautery was used to detach the coracoacromial ligament from the anterior acromion, and a motorized burr was then used to perform an anterior acromioplasty with care taken not to violate the deltoid origin. At the conclusion of the acromioplasty, the undersurface of the acromion was smooth and flat, and there was approximately 1.5 cm of distance between the undersurface of the acromion and the underlying surface of the rotator cuff tendon, consistent with an adequate subacromial decompression."

We got a denial when we reported 29825 (Arthroscopy, shoulder, surgical; with lysis and resection of adhesions, with or without manipulation) and 29826 (Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament [i.e. arch] release , when performed [List separately in addition to code for primary procedure]). Can you please help us understand the reason for this denial?

New York Subscriber

Answer: The reason for your denial is that your payer has not updated the system for the current version 18.1 (effective April 1st 2012) of NCCI. The new edits allow that 29825 and 29826 can be reported together. But in previous versions of NCCI, the code 29825 was a column two code to column one code 29826.