Wiki Shoulder chondroplasty of the glenoid and microfracture

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I would like to get the opinions of some fellow coders in regards to a CPT for a shoulder surgery one of our specialist has done. He did the following:

1. Left shoulder arthroscopy with debridement of superior labral tear and partial-thickness subscapularis tendon tear (CPT 29823)
2. Left shoulder chondroplasty of the glenoid and microfracture of a full-thickness chondral lesion of the proximal anterior aspect of the glenoid (CPT ?)
3. Left shoulder arthroscopic subacromial decompression (CPT 29826)
4. Left shoulder arthroscopic rotator cuff repair (CPT 29827)

Are question is would procedure number 2 be bundled into 29823 or would you code as 29999 an unlisted and compare to CPT 29823. Any help you can lead would be greatly appreciated. Thank you in advance…

Jessyka B, CPC
Coding and Billing Specialist
 
I am still researching for the record I'm currently auditing, but it appears that 29823 extensive debridement should include 3 or more structures, and the chondroplasty would be inclusive - not my final answer, and I would urge you to do your own research.
 
nolanspade said:
I am still researching for the record I'm currently auditing, but it appears that 29823 extensive debridement should include 3 or more structures, and the chondroplasty would be inclusive - not my final answer, and I would urge you to do your own research.
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Side note - you are answering a post from seven years ago. In the meantime, the descriptions of CPT 29822 and 29823 were changed in 2021. Further, NCCI edits/manual language changed at various times from 2017-present. It is correct now that the wording for 29823 is: Arthroscopy, shoulder, surgical; debridement, extensive, 3 or more discrete structures (e.g., 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]); and the chondroplasty of the glenoid would be counted in that as a structure. Prior to 2021, the wording was vague for 29822 and 29823 (e.g.; 29823 Arthroscopy, shoulder, surgical; debridement, extensive.)

Would have to see the op note of what the person listed from the header there. #1 would not have been 29823, even in 2017, because the debridement of the subscap would have been included in the rotator cuff repair. I am not sure what the current advice is on microfracture of the glenoid. Some would say 29999, others would probably say count it as part of debridement. In the example above, if being done now, you would still count the subscap work as part of the RCR. If the labral debridement from #1 was counted and the glenoid work from #2 was counted, that would only be 2 discrete structures so it would not meet 29823. You would be left with 29827, 29826 and depending on how one wanted to do it, maybe 29999 but I am not sure that would fly for the microfracture. I don't have CPT Assistant right now but that needs to be checked as well.
 
Not sure if relevant anymore, given the original post was in 2017... But Amy's points are right on target.

You -could- attempt to code 29999 and compare to microfracture in the knee (29879) but given that there is no great literature on this, it is unlikely to get reimbursed and would be considered experimental by 3rd party payors. I have done it several times (to no great effect, but that's not relevant) and it has taken less than 3-4 minutes of operative time, and really is hard to justify as a separate procedure.

Chondroplasty would be considered debridement of humeral/glenoid cartilage, each of which counts as a structure for 29823 and is bundled.
N.
 
I came across this thread during my research for debridement counted towards CPT 29823 and was hoping I could piggyback off of the original posters question. I code for an ASC and see debridement quite often.

I have been under the impression that if you complete a rotator cuff repair (ex: subscapularis) you cannot count debridement of the other tendons of the rotator cuff (infraspinatus, subscapularis) towards your separate structures of debridement for 29823.

I have an operative report that states operations performed: Left shoulder arthroscopy with arthroscopic rotator cuff repair, extensive debridement, subacromial decompression, and arthroscopic biceps tenodesis. and FINDINGS: Upper border subscapularis tear that was repaired with a horizontal mattress with same SwiveLock as the biceps tenodesis

DESCRIPTION OF PROCEDURE:
I went into the glenohumeral joint and did a diagnostic arthroscopy. I inserted a spinal needle in the anterior portal slightly higher and lateral to aid in tenodesis fixation. I inserted an electrocautery and did diagnostic arthroscopy. There was fraying at the junction of the bicipital groove as well as the subscapularis, and there was defect there anteriorly and slightly inferiorly. At that time, I cleared off the fascial layer on the superficial side of the subscapularis to aid in passing the sutures. I cleaned up around the bicipital groove, and then, by using shaver, I shaved some of the anterior and posterior labral tissue and then used electrocautery to shrink that area back down to the room of the bone. Following this, I then inserted a Scorpion passer and went in around and in the tendon stump just proximal to the bicipital groove. Following this, there were no soft tissue bridges. I then inserted the same anterior portal superficial to deep tape that I used as a horizontal mattress. I inserted a shaver and debrided the footprint to aid in healing. Following this, I then inserted a 4.75-mm SwiveLock after I had loaded the anchor. I used a swivel punch and then followed by the anchor and tightened them appropriately. Following this, they moved as a unit. I then went up into the subacromial space, and the patient had extensive bursitis throughout. This was debrided away after I made a lateral portal with spinal needle. I used a combination of a shaver, and once I did that I peeled off the inferior aspect of the acromion, and there was more of an anterior bone spur than anything and I used after I placed in the posterior portal. I internally and externally rotated the shoulder and did not see any full-thickness rotator cuff tears and confirmed the findings on the MRI. Following this, I debrided the subdeltoid space and then some slight mild fraying of the rotator cuff and that was at the level of where the bone spur was. I then let the water out and closed with 3-0 nylon, Xeroform, 4x4's, ABD, Mediport tape.

Based on this operative report would you code 29823? Payer: Medicare- My initial thought is no, however I feel as though there may be something I am missing. Our ASC does not have access to CPT assistant, AAOS, or any electronic coding tools.

Thank you for taking the time to read my post and I appreciate and insight you may be able to offer to lead me to further detailed information on the topic.
 
Kellie,

Unfortunately, this operative report is gibberish. As an orthopaedic surgeon who performs multiple open and arthroscopic shoulder surgeries a week, I cannot tell you definitively what was done, as the dictation is grammatically so sloppy, with unclear antecedents to pronouns, that it is unclear for most of the procedure (a) whether the surgeon is talking about the biceps tendon or the subscapularis tendon, (b) whether a bony decompression was actually performed and (c) what he is talking about with regards to the labrum.

Assuming your surgeon did, in fact, both tenodese the biceps and repair the subscapularis (29827, 29828), the debridement of the labrum and bursa would each be considered one structure for the purposes of debridement (i.e. 29822 - which is included within the above codes and not separately reimbursable). I do not see how this would rise to the level of 29823, given not enough structures are clearly debrided, and rotator cuff and biceps cannot be counted twice. Furthermore, there is not clearly documented bony decompression of the acromion. If the surgeon wishes to bill 29826, this would need to be better spelled out.

Frankly, I would ask the surgeon to provide an addendum to clarify in order to make these services billable and prevent denials.
N
 
nraizman@gmail.com said:
Kellie,

Unfortunately, this operative report is gibberish. As an orthopaedic surgeon who performs multiple open and arthroscopic shoulder surgeries a week, I cannot tell you definitively what was done, as the dictation is grammatically so sloppy, with unclear antecedents to pronouns, that it is unclear for most of the procedure (a) whether the surgeon is talking about the biceps tendon or the subscapularis tendon, (b) whether a bony decompression was actually performed and (c) what he is talking about with regards to the labrum.

Assuming your surgeon did, in fact, both tenodese the biceps and repair the subscapularis (29827, 29828), the debridement of the labrum and bursa would each be considered one structure for the purposes of debridement (i.e. 29822 - which is included within the above codes and not separately reimbursable). I do not see how this would rise to the level of 29823, given not enough structures are clearly debrided, and rotator cuff and biceps cannot be counted twice. Furthermore, there is not clearly documented bony decompression of the acromion. If the surgeon wishes to bill 29826, this would need to be better spelled out.

Frankly, I would ask the surgeon to provide an addendum to clarify in order to make these services billable and prevent denials.
N
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Dr. Raizman, thank you for such a quick response, your input is very much appreciated.
 
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