Orthopedic Coding Alert

Question: I’m not sure if I should use the extensive debridement code or the limited debridement code. My provider performed a labral debridement, articular shaving and chondroplasty, with a diagnostic arthroscopy. That sounds extensive to me, so should I use the extensive code 29823 or the limited code 29822?

Idaho Subscriber

Answer: Your surgeon must include the qualifying terms “limited” or “extensive” in the documentation. One can perform an extensive debridement of one structure (the entire labral circumference) or a limited debridement of multiple structures. The only one in a position to qualify the extent of the procedure is the surgeon, and if he fails to do so, it is a documentation deficiency that must be addressed.

The limited code is 29822 (Arthroscopy, shoulder, surgical; debridement, limited). The procedures that you described fulfill the requirements of a limited debridement, but again, you need to ask the physician to specify this in the documentation.

The American Academy of Orthopaedic Surgeons (AAOS) Global Service Data for Orthopaedic Surgery provides a helpful guide to understanding which code to use. They define a limited debridement procedure as an operation that includes labral debridement, synovectomy, removal of humeral or glenoid osteophytes, articular shaving and/or chondroplasty, and diagnostic arthroscopy. For these cases, use the 29822 code.

An extensive debridement includes the list of procedures involved in a limited debridement but also adds a few more. The following procedures, including a biceps tendon and rotator cuff debridement and abrasion arthroplasty, must be included to satisfy the requirements of an extensive debridement.

The AAOS also issued a guideline for 29823 (… debridement, extensive) that you can use it if the debridement occurs in the anterior and posterior aspects of the joint. However, your physician must document it. Many coders lean toward using the more expensive 29823 code, but know that this code can only be used if your physician documents the procedure as being extensive.