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ChelseaDelph

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Good Morning,

Does anyone have any good articles or could provide some additional information when billing rotator cuff surgeries with acromioplasty and debridement. Specific codes are: 23410, 23412, 29823, 29822, 29826, 29828, 29827. There are lots of bundling when some of these codes are used together and most specifically I'm trying to determine what codes can be billed when a rotator cuff repair is done with an acromioplasty. I seem to have issues when the acromioplasty is done arthroscopically but then the rotator cuff repair is done open.
 
There has been a lot of discussion on this. If you search the forums here, look for recent (2022, 2023) posts with key words like debridement, shoulder, RCR, rotator cuff, 29823, 29822, etc.

Checking payer policies is a good place to start, NCCI P2P edits, and the Medicare NCCI manual. https://www.cms.gov/files/document/medicare-ncci-policy-manual-2023-chapter-4.pdf
NCCI info snip from Chapter 4 MSK: "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 adifferent 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."

Always be sure to check the year when using resources.

There is always a lot of confusion and debate on these but the CPT manual, NCCI edits, payer policy, CPT Assistant articles, and a reputable source like AAOS have the answers. It also will depend on the specific documentation in the op report. Once you undertand the basics, anatomy and edits you can do them confidently.

Some references: https://karenzupko.com/arthroscopy-coding-for-major-joint-shoulder/
The AAOS Complete Global Service Data Books would help you as well to see what is or is not considered included (note this can differ from what a payer thinks). https://www5.aaos.org/store/product/?productId=20089615&ssopc=1
 
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