In my opinion, for new folks, shoulder scopes are the most confusing and difficult to code aside from hip scopes or big, multi-procedure knee scopes. Agree, anatomy is the basis for all coding. You would also want to understand NCCI edits, the NCCI manual and have an AAOS Complete Global Service Data book set which is really helpful. CPT Assistant is also necessary. AAOS/Zupko conferences and webinars are also helpful. Especially if you are only going to be coding orthopedics.
The best thing to do is look at the header and jot down what you think the codes are per each procedure. Then go to the body of the op note and find that the procedures are listed and described in detail. Use a highlighter on paper if you can, if not use scratch paper (or electronically). Then you can take those codes and run through NCCI to see what bundles, etc. If you find something stated in the body is not in the header or vice versa, it may be query time.
On this note, in the header, you would have noted 1. 29821 (complete synovectomy), 2. 29825 (lysis), 3. 29828 (tenodesis). The body of the note describes all three. Paragraph #3 has debridement of the labrum and rotator cuff (supraspinatus and infraspinatus not called out in the header - 29822) and synovectomy (29821). Paragraph #4 has the lysis (29825) and biceps tenodesis (29828).
From your code choices listed above, you are missing the biceps tenodesis which is the main procedure here - 29828. In this case if you were to run these through NCCI, you can only report the 29828 because the other procedures bundle into that. While it says a modifier "may be allowed" I personally would not append 59 to the 29821 or 29825. Generally, lysis, synovectomy, and limited debridement are always going to bundle into the "greater" procedure. Further, 29825 bundles into 29821 also. I guess some would argue on that and append a 59 to 29821 and 29825. I don't have a current AAOS book but my 2020 one says those are not included in the global of the others, but it goes against the NCCI manual (see below). If it was Work Comp I would report it. You also have to consider if the payer is following CMS or not.
"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."
"7. Shoulder arthroscopy procedures include limited debridement (e.g., CPT code 29822) even if the limited debridement is performed in a different area of the same shoulder than the other procedure. With 3 exceptions, shoulder arthroscopy procedures include extensive debridement (e.g., CPT code 29823) even if the extensive debridement is performed in a different area of the same shoulder than the other procedure. CPT codes 29824 (Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure)), 29827 (Arthroscopy, shoulder, surgical; with rotator cuff repair), and 29828 (Arthroscopy, shoulder, surgical; biceps tenodesis) may be reported separately with CPT code 29823 if the extensive debridement is performed in a different area of the same shoulder."
Don't get discouraged, shoulder scopes are hard.
