Wiki 29806 w/ 29807?

cclarson

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Hello Everyone, I'm trying to decipher this dictation and figure out if this warrants both 29806 and 29807, or just 29807. I think that it would be only 29807 w/ 29822-59 based on the documentation. Thoughts?

POSTOPERATIVE DIAGNOSES:
1. Right shoulder posterior labral tear.
2. Right shoulder superior labrum anterior and posterior tear.
3. Right shoulder partial-thickness rotator cuff tear.

PROCEDURES PERFORMED:
1. Right shoulder arthroscopic posterior labral repair, CPT code 29806.
2. Right shoulder arthroscopic superior labrum anterior and posterior repair, CPT code 29807.
3. Right shoulder arthroscopic rotator cuff debridement.

INDICATIONS FOR SURGERY: The patient is a 34-year-old male who sustained an injury at work when it was stuck in as he was attempting to dislodge and he felt pain in his shoulder. He had undergone conservative treatment of this including anti-inflammatories, modification of activities, but continued to have significant pain and dysfunction. He was sent to me for evaluation and treatment. I was concerned about the possibility of a posterior labral tear. An MRI was obtained, which confirmed a large posterior labral tear, and he also appeared to have a SLAP type of tear and some fraying of the underside of his supraspinatus and infraspinatus insertion. Given his failure of conservative treatment and the large size of his tear, I recommended surgical intervention. I recommended arthroscopic repair of his posterior labral tear with likely repair of his superior labral tear component. I discussed debridement versus repair of his rotator cuff tear as well. The risks, benefits, and alternatives were discussed including the risk of bleeding, infection, failure of any repair, continued shoulder pain and dysfunction, and possible need for more surgery. The patient understood these risks and agreed to proceed.

DESCRIPTION OF PROCEDURE: The patient was identified and marked in the preoperative area. His H&P and consent form were signed and updated. He was taken to the operating room. After, a regional block was placed. He was intubated and sedated. He was placed in the lateral position with his right side up. His right upper extremity was prepped and draped in a normal sterile fashion. Preoperative antibiotics were given.

After a surgical time-out was performed, we started with the posterior portal. I made this just off the posterolateral corner of the acromion and entered the glenohumeral space and then made our anterior portal under direct visualization. I made the first one little bit more medially, so we could put a large cannula in here to serve as a working cannula. I then made a second portal site more superior and laterally up towards the insertion of the subscapularis. I decided first to work anteriorly while viewing from the posterior portal. We used the probe to examine the joint first and defined our pathology. He did not have any significant degenerative changes in the glenohumeral joint. His biceps tendon was intact. His subscapularis was intact with just a little bit of fraying around the superior edge. We debrided this back with a shaver to a stable edge. The rotator cuff insertion of the supraspinatus and infraspinatus also had some undersurface tearing out at the footprint. I debrided this with a shaver as well back to a stable base. I did not think that it involved more than 10-15% of the rotator cuff footprint, so I did not need any sort of repair. Finally, we looked at our pathology of labrum. He had a very large labral tear. This extended from about 7 o'clock posterior position all the way up to the entirety of the posterior labrum, the entirety of the superior labrum, and then going into about the 2 o'clock position or so in the anterior labrum. The anteroinferior portion of the labrum was intact.

As mentioned, I decided to work on the anterior portion first. I used a shaver to debride this anterior labrum. I elected to place an anchor up at about the 1 o'clock position or so. I thought that this would both stabilize the extension of the tear into the anterior labrum and then also stabilize our biceps insertion. We used an Arthrex PushLock anchor repair. I used a SutureLasso and grabbed underneath the entirety of the labrum. We grabbed the lasso from our accessory portal and passed the suture through this lasso and then pulled the suture passer back through the labrum. We then grabbed the other end of the LabralTape, and this allowed us to circumferential suture around the labrum. We then drilled for and placed our PushLock anchor at about the 1 o'clock position. This provided a nice repair of our anterior and superior labrum. It seemed to be very stable after this repair.

At this point, we switched and started viewing from the anterior accessory portal and then working through our posterior portal. We enlarged this to place a larger cannula back here. I actually thought we had good position with our initial portal placement and did not need any accessory portals. We repeated the same process using the PushLock anchor from Arthrex and using the SutureLasso to pass through the labrum first and then placed our anchor. We ended up placing 3 posterior labral anchors, 1 down about the 8 o'clock position, 1 at about the 9:30 position, and then 1 up close to 11 o'clock position. These provided excellent stability of the posterior labrum. I also thawed our superior labral insertion. Now with the biceps tendon was intact and did not need any further repairs. Final arthroscopic images were obtained to confirm our repair and stability of the labrum.

At this point, we removed our arthroscopic instruments. We closed the portal sites with nylon sutures. Sterile dressings were applied. The patient's arm was placed in a sling. He was awakened from anesthesia and taken to the recovery area in stable condition.
 
You can't report 29806 & 29807 together. You can't report 29822 unless it's billed on its own. So you can eliminate two codes right from the start.
That's what I thought, but I wanted to confirm since the doctor had even put both codes in the dictation itself, which he normally never does. So just 29807 for this date of service?
 
When 29806 & 29807 are both performed, 29806 is the primary procedure.
is there documentation that you can provide or resource that will help explain this? I have providers that are wanting documentation other than the CCI edits to support not billing both codes. I have run out of resources or documentation to help explain this.
 
is there documentation that you can provide or resource that will help explain this? I have providers that are wanting documentation other than the CCI edits to support not billing both codes. I have run out of resources or documentation to help explain this.
This thread is really old. However it is NCCI edits. You would refer to the NCCI P2P edits and the NCCI manual.
29806 is primary to 29807.
O. Misuse of Column Two Code with Column One Code (Misuse of Code Edit Rationale)

Also: https://www.cms.gov/files/document/medicare-ncci-policy-manual-2023-chapter-4.pdf
4. With 3 exceptions (which are described in Chapter IV, Section E (Arthroscopy), Subsection 7), an NCCI PTP edit code pair consisting of 2 codes describing 2 shoulder arthroscopy procedures shall not be bypassed with an NCCI PTP-associated modifier when the 2 procedures are performed on the ipsilateral shoulder. This type of edit may be bypassed with an NCCI PTP-associated modifier only if the 2 procedures are performed on contralateral shoulders.

Same question regarding 29806/29807 with references discussed here Question - Help with shoulder surgery
Old but has an AAOS link: 29806 & 29807??

Not all payers will care what AAOS says in the GSD but you can try if it is Type II or Type IV and documentation is there. Again, it is going to require a 59 mod, and not all payers will care. WC may be different.
 
is there documentation that you can provide or resource that will help explain this? I have providers that are wanting documentation other than the CCI edits to support not billing both codes. I have run out of resources or documentation to help explain this.
I wished I could help you. It always amazes me that providers don't want to heed the NCCI edits. They can bill both, but they won't both get paid and if you bill it repeatedly that could be interpreted as an attempt to defraud.
 
Another perspective: Head Off Costly Penalties for Shoulder Unbundling Errors

Error #3: Unbundling 29806 and 29807 for SLAP

A clear understanding of shoulder anatomy is essential to correctly code a labrum repair. You must understand exactly where on the labrum the repair was performed. The surgeon will determine if the procedure qualifies as a Superior Labral Tear from Anterior to Posterior or SLAP — not all labrum repairs are SLAPs.

If the repair is a SLAP, you’d code work done on the upper half of the labrum as 29807 (Arthroscopy, shoulder, surgical; repair of SLAP lesion). If the repair was in the lower half of the labrum, you’d use instead code 29806 (Arthroscopy, shoulder, surgical; capsulorraphy).

Now, if the surgeon works on both the upper and lower labrum, you cannot simply unbundle and code both 29806 and 29807. According to the National Correct Coding Initiative (NCCI) edits, 29806 is bundled with the following codes:

  • 29807 − SLAP repair
  • 29827 − biceps tenodesis
  • 29828 – rotator cuff repair
If the surgeon documents work in both the upper and lower labrum, you’d report 29807 with modifier 22 appended.

So, when can you unbundle 29806 and 29807? You may use modifier 59 to unbundle these codes when the surgeon performs a capsulorraphy that is unrelated to the labrum tear. You must have documentation that substantiates that the capsular defect is unrelated to the labrum tear. Caution: The surgeon may repair the labrum by attaching it to the capsule. That doesn’t qualify as a “separate and distinct” capsulorraphy.
 
Hi, I work for an orthopedic office and I am coding an arthroscopic surgery. One procedure has me a little stumped... if anyone can help that would be nice, please.

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The description:

There was a separate labral tearing anteriorly and inferiorly, a full thickness type of a tear.

We then began the repair using a suture lasso to pass a monofilament around the labral tear inferiorly. We replaced this with a #2 UltraLoop suture from Smith & Nephew. Then we used a 2.9-mm drill bit to drill a hole on the anterior inferior glenoid along the rim and then we incorporated the #2 UltraLoop suture within the MicroRaptor knotless anchor and we seated the anchor in the aforementioned drill hole with the arm held in slight external rotation to repair the anterior inferior labral tear. Once this was accomplished, we then removed excess suture material and then hemostasis was achieved.

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29807 - Arthroscopy, shoulder, surgical; repair of SLAP lesion (SLAP includes the superior and posterior portion of the labrum, however, this is a full thickness anterior inferior labrum tear).

29806 - Arthroscopy, shoulder, surgical; capsulorrhaphy (which is meant to repair the torn capsule around the shoulder joint, which I believe includes the torn
anterior inferior labrum, but I am not 100%, hence I am seeking your thoughts) The only doubt I have is because there, although there is no mention of a bankart tear, a bankart tear can be repaired in a capsulorrhaphy BUT this anterior inferior tear is a full thickness tear and bankart tears are not full thickness tears.

or do you see a better suited code?

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Is 29806 simply because the repair is on the lower half of the labrum, although there is no mention of the 'capsule'?

Thank you
What else was done during the case, anything?
 
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