Wiki 29823 or 29826

cherylbr

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Unsure if this should be 29828, 29823 or 29828, 29826.
Can the removal of spur from the subacromial space be used as the 3rd debridement of the shoulder.

Postoperative Diagnosis:
1.Partial rotator cuff tear, right shoulder.
2.Labral tear anterior, posterior and superior labral complex.
3.Biceps partial tear/tendinitis.
4.Impingement syndrome.
Procedure Performed:
1.Arthroscopic surgery of the right shoulder with debridement of the rotator cuff and anterior, posterior, and superior labral complex.
2.Biceps tenodesis arthroscopically.
3.Subacromial decompression with release of the CA ligament.
4.Application of Breg SlingShot sling.

Description of Procedure: The patient was brought to the operating room. A time-out procedure was performed as per our protocol. Antibiotics were infused as per our protocol. The right shoulder was prepped and draped in the usual sterile fashion. All bony prominences had been well padded and the neck was placed in neutral position. The eyes were protected and sealed very nicely. It should be noted that an interscalene block had been performed by the department of anesthesia for postoperative pain control at my request. Portals were pre-injected with 2 mL of Marcaine each. Posterior portal was made. A 15-point inspection was performed. Type 1 labral tearing anterior, posterior, and superior labral complexes were debrided through a 7-mm Arthrex cannula with a 3.5 straight shaver until there were no loose edges or transition zones. At this point, the glenohumeral joint was assessed. There was no significant degenerative changes in the glenohumeral joint. There were no loose pieces. The rotator cuff was intact from the articular standpoint. The biceps tendon showed considerable fraying and inflammation. A Loop 'N' Tack was selected from Arthrex and the FiberWire was placed and looped up with the piercing device from Arthrex through the 7-mm Arthrex cannula. The loop was placed securely in the biceps tendon itself. Secure fixation was obtained with a FiberWire and using an ArthroCare type wand, the biceps was released. A shaver was used to debride the stump of the biceps until it was very smooth. At this point, our attention turned to a small incision made percutaneously. A longitudinal split in the rotator cuff was very small and this was over the bicipital groove. A 4.75 SwiveLock was inserted and the biceps was tenodesed nicely into this bicipital groove arthroscopically. Excellent secure fixation was obtained on the biceps itself. At this point, our attention turned to subacromial space where a thick bursitis was noted. A rather large anterolateral spur was noted as well. A subacromial decompression was performed removing all of the bursitis, removing the spur using a cutting block type technique. The CA ligament was released with an ArthroCare type wand. All loose pieces were removed. The rotator cuff showed minimal fraying from a bursal standpoint. This was debrided with a 3.5 straight shaver until there were no loose edges or transition zones. This was done without difficulty. At this point, a copious amount of irrigation was utilized. Hemostasis was maintained throughout the case with an ArthroCare type wand. At this point, 10 mL of 0.25% Marcaine was injected intra-articularly. The portals were closed with 4-0 nylon in simple interrupted fashion, followed by sterile dressings, followed by shoulder tape, followed by a Breg SlingShot sling. At this point, the patient was transferred to the recovery room in stable and satisfactory condition having tolerated the procedure well. There were no complications.
 
Arthroscopic shoulder debridement code changes
CPT Assistant, December 2020 Page: 8 Category:

Related Information

Revisions to Arthroscopic Shoulder Debridement Codes

Current Procedural Terminology (CPT®) codes (29822, 29823) for arthroscopic shoulder debridement have been the source of much confusion within the coding community. Over the years, countless questions have been submitted to the CPT® Network on this topic and these codes are associated with many of the frequently asked questions in various editions of CPT® Assistant. To help prevent continued confusion and provide better clarification, new guidelines have been added and codes 29822 and 29823 have been revised for the CPT® 2021 code set. This article provides an overview of these revisions.

Endoscopy/Arthroscopy
The new guidelines added to the Endoscopy/Arthroscopy subsection clarify that arthroscopic removal of loose body(ies) or foreign body(ies) may be reported only when the loose body(ies) or foreign body(ies) is equal to or larger than the diameter of the arthroscopic cannula(s) used for the specific procedure, and can only be removed through a cannula larger than that used for the specific procedure or through a separate incision or through a portal that has been enlarged to allow removal of the loose or foreign body(ies).

29806 Arthroscopy, shoulder, surgical; capsulorrhaphy

29822debridement, 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])

(For open procedure, see specific open shoulder procedure performed)

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])

(For open procedure, see specific open shoulder procedure performed)
 
I do understand per CCI that you cannot bill the 29822 however, you can bill 29823 debridement 3 or more structures with the biceps tenodesis code 29828. Since alot of the insurances do not reimburse for code 29826 acromioplasty is it correct to use the debridement done for the spur removal of the acromion as one of the debridements for qualifying for the 3 structures of debridement and not bill the 29826?
 
I would probably report 29828 & 29823-59 if your payer does not cover 29826. Seems crazy to only get 29828 for what is described. The NCCI manual says you can report 29823 w/ 29828 for debridement done in a different area (s) of the same shoulder. If you don't report 29826, you technically have 3 or more discrete structures described in the report: (1) "Type 1 labral tearing anterior, posterior, and superior labral complexes were debrided", (2) "The rotator cuff showed minimal fraying from a bursal standpoint. This was debrided with a 3.5 straight shaver", (3) "subacromial space where a thick bursitis was noted. A rather large anterolateral spur was noted as well. A subacromial decompression was performed removing all of the bursitis, removing the spur using a cutting block type technique. The CA ligament was released with an ArthroCare type wand."

The only thing you might run into is the header listing the procedures says SAD and debridement of only 2 structures (RC/labrum). The description of the procedure in the body, while it "could" be called debridement really is SAD which matches the header.

On the other side of things, if I was auditing this for a payer, I would probably deny the 29823 since it's really 29826, even though the payer may or may not pay that. If you take away the SAD work you are only left with 2 structures which equates to 29822.

I think it all comes down to knowing who you are billing this to and checking to see if they pay 29826.
 
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