Full Answer
Debridement may be done in arthroscopic surgery (through two or three tiny incisions) or in open surgery (usually one larger incision). It is often part of rotator cuff repair surgery.
Biceps tenodesis, or transferring the attachment of the biceps to the humerus (23430/29828), may be reported separately, according to CPT® Assistant (July 2016), and is not part of a normal rotator cuff repair.
CPT® code 29822 Arthroscopy, shoulder, surgical; debridement, limited includes debridement of soft or hard tissue.
29822New. I know that Arthroscopic Biceps Tenotomy is coded as CPT 29822 (limited debridement). The surgeon also performed Arthroscopic Rotator Cuff Repair, AC joint resection and Subacromial decompression & acromioplasty.
A fifth muscle, the long head of biceps, while not technically part of the rotator cuff, also plays a major role. Muscles attach to bones via a tendon; the rotator cuff tendons all attach at the front shoulder on the upper arm bone called the humerus.
Biceps tenodesis involves cutting the biceps tendon off the labrum, which is the pad of cartilage inside the glenoid, and reattaching it to the humerus (upper arm bone). Biceps tenotomy means cutting off one tendon and not reattaching it, allowing it to heal to the humerus over a few weeks.
Debridement involves removing loose fragments of tendon, thickened bursa, and other debris from around the shoulder joint. By clearing damaged tissue from the region of the shoulder joint, it helps the doctor to see the extent of the injury and determine whether you need more surgery.
The CPT codes 23405–Tenotomy biceps tendon, 23430–Open tenodesis of long tendon of biceps (LTB), and 29828–Arthroscopic biceps tenodesis were used to represent the patient population.
Subacromial Decompression with Partial Acromioplasty (29826) Keep in mind that CPT 29826 is an add-on code and requires a primary procedure code. It also requires both a subacromial decompression and a partial acromioplasty. If an acromioplasty is not performed, report only a debridement.
Here is the difference between LIMITED and EXTENSIVE debridement: If the surgeon debrides 1 to 2 “discrete structures” in the shoulder, it's limited (29822). If the surgeon debrides 3 or more, it would be coded as extensive (29823). Bone and soft tissues qualify as discrete structures.
If you are having a tenotomy, your biceps tendon is cut at its base by the top of your shoulder socket and the tendon is allowed to retract out of the joint. In about half of patients they will notice the contour of their biceps muscle changes (this is called a Popeye sign). Performing a tenotomy is safe and effective.
What is the biceps tenodesis procedure? The biceps tenodesis procedure treats shoulder and biceps muscle pain and weakness that happens when you tear your long head biceps tendon. This tendon is located at the top of your bicep muscle. It's connected to your labrum, which is cartilage that lines your shoulder socket.
Orthopedics. Medicare edits bundle Procedure 29823 (Arthroscopy, shoulder extensive debridement) into Procedure 29824 (Arthroscopy, shoulder, surgical; distal claviculectomy) at this time but allows for a modifier if the debridement is performed separate and distinct from the distal claviculectomy.
CPT Code CPT Description 29827 Arthroscopy, shoulder, surgical; with rotator cuff repair The provider examines the tissue inside the shoulder joint with an arthroscope. She inserts additional instruments to repair a torn rotator cuff, the grouping of muscles and tendons that surround and support the shoulder joint. Rotator cuff tears…
This email will focus on changes to CPT Codes 29822/29823 debridements relative to the shoulder. It will help you determine when the removals are separate and distinct from other procedures performed in the same operative session as well as the difference between limited vs. extensive debridements as it relates to 29822/29823.
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Description If another arthroscopy procedure is billed and paid for the same day, on the same shoulder, for the same beneficiary, at the same encounter, the limited debridement (code 29822) is not separately payable and Current Procedural Terminology (CPT) code 29822 will be denied. “Shoulder arthroscopy procedures include limited debridement (e.g., CPT code 29822) even if the limited ...
Shoulder arthroscopy codes encompass two joints in the shoulder area: the glenohumeral joint (typically called the shoulder joint) and the acromioclavicular joint. The acromioclavicular joint is the smaller of the two and there are arthroscopy codes specific to it; excision of the distal clavicle, 29824 Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure) and decompression of the subacromial space, 29826 Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or without coracoacromial release, which includes partial excision of the acromion or acromioplasty.#N#Arthroscopic debridement of the labrum and of the undersurface of the rotator cuff (29822 Arthroscopy, shoulder, surgical; debridement, limited) may be reported separately when performed with subacromial decompression (29826), according to the May 2001 CPT® Assistant. Per the same edition, Subacromial decompression includes acromioplasty, arch decompression, excision of bursa, and coracoacromial ligament release.#N#Open procedures 23410, 23412, and 23420 differentiate between whether the tear is acute or chronic or how many tendons are repaired. The arthroscopic code for rotator cuff repair (29827 Arthroscopy, shoulder, surgical; with rotator cuff repair) makes no such distinctions, and can be reported whether the tear is acute or chronic; whether one, two or three tendons are repaired, or; whether one or more portals is required to repair the cuff (February 2008 CPT® Assistant).#N#Often the surgeon will perform a biceps tenotomy (i.e., tendon release) via arthroscopy, and then perform a tenodesis via an open procedure. In such cases, the code for open biceps tenodesis (23430 Tenodesis of long tendon of biceps) is most appropriate. Only assign the code for arthroscopic biceps when the tenodesis portion of the procedure is performed via arthroscope.#N#Arthroscopic capsular shrinkage (i.e., thermal capsulorrhaphy) is at times used to treat joint instability. For payers recognizing HCPCS Level II S codes, S2300 Arthroscopy, shoulder, surgical; with thermally-induced capsulorrhaphy is appropriate for these procedures. For payers who do not recognize S codes, CPT®29999 Unlisted procedure, arthroscopy is appropriate. This procedure generally is considered investigational and not payable by many payers.
Often the surgeon will perform a biceps tenotomy (i.e., tendon release) via arthroscopy, and then perform a tenodesis via an open procedure. In such cases, the code for open biceps tenodesis (23430 Tenodesis of long tendon of biceps) is most appropriate.
The compartment coding concept is important for coding arthroscopic procedures in the knee accurately.#N#The code for arthroscopic abrasion arthroplasty, multiple drilling and/or microfracture (29879 Arthroscopy, knee, surg ical; abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture) may be coded per compartment so you should code microfracture of both medial and lateral femoral condyles as 29879, 29879-59 Distinct procedural service.#N#As the descriptor states, chondroplasty (29877 Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)) is included in 29879 when chondroplasty is performed in the same compartment. However, a chondroplasty performed in a separate compartment may be reported separately to 29877-59 (August 2001 CPT® Assistant).#N#For Medicare, G0289 Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee may be reported once for a chondroplasty and/or loose body removal performed in each compartment where it is the only procedure performed. In contrast to 29879, report code 29877 only once per knee, regardless of the number of compartments in which it is performed (December 2005 CPT® Assistant).#N#An often overlooked code is 29884 Arthroscopy, knee, surgical; with lysis of adhesions, with or without manipulation (separate procedure), which may be assigned for excision of fibrosis/adhesions/scar due to previous procedures or injuries. Debridement of cyclops lesions after total knee replacement (s) is a common condition for which arthroscopic lysis of adhesions is performed. Code 29884 is considered to be included in any other major arthroscopic procedure performed in the knee, regardless of whether it is performed in a separate compartment.#N#When synthetic plugs are used for osteochondral grafting of the knee (i.e., mosaicplasty), 29867 Arthroscopy, knee, surgical; osteochondral allograft (eg, mosaicplasty) may be assigned, even though the descriptor refers to allograft, per the December 2008 CPT® Assistant. The same, however, does not apply for the ankle. Rather than assign code 29892 Arthroscopically aided repair of large osteochondritis dissecans lesion, talar dome fracture, or tibial plafond fracture, with or without internal fixation (includes arthroscopy) for placement of synthetic material, report unlisted code 28899 Unlisted procedure, foot or toes.
Code 29884 is considered to be included in any other major arthroscopic procedure performed in the knee, regardless of whether it is performed in a separate compartment. When synthetic plugs are used for osteochondral grafting of the knee (i.e., mosaicplasty), 29867 Arthroscopy, knee, surgical; osteochondral allograft (eg, ...
Arthroscopy refers to less invasive procedures in which an endoscope is placed within the joint for the performance of diagnostic and therapeutic procedures. As technology advances, procedures previously performed through large incisions are now performed arthroscopically. To accommodate this emerging technology, new arthroscopy, ...
Note: Two codes in this section (29848 Endoscopy, wrist, surgical, with release of transverse carpal ligament and 29893 Endoscopic plantar fasciotomy) are not technically arthroscopies (that is, they are not endoscopies within a joint), but rather are musculoskeletal endoscopies.
I agree with orthocoderpgu.#N#Per the 2019 NCCI Policy Manual (Chapter 4 #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."
I know that Arthroscopic Biceps Tenotomy is coded as CPT 29822 (limited debridement). The surgeon also performed Arthroscopic Rotator Cuff Repair, AC joint resection and Subacromial decompression & acromioplasty. I know that with the limited debridement, it can't be coded separately per the NCCI edit. Can the 29822 for Biceps tenotomy be billed separately?
With shoulder coding, if it hits an edit, it can't be billed unless done on the opposite shoulder. So no, you can't use 29822 to bill for the tenotomy when RTC repair was performed and other restorative procedures. S.
Do not report both the open and arthroscopic codes with modifier 59 because the work was performed in the same anatomic location during the session. Coding for arthroscopic shoulder surgery is complex, and coding errors are common. Although the information in this article is not exhaustive, it’s important.
CPT® code 29822 Arthroscopy, shoulder, surgical; debridement, limited includes debridement of soft or hard tissue. Debridement in a single area of the shoulder is considered limited debridement. CPT® code 29823 Arthroscopy, shoulder, surgical; debridement, extensiv e includes debridement of multiple soft structures, multiple hard structures, or a combination of both.#N#Limited and extensive debridement are included in other shoulder arthroscopy procedures, even if the debridement is performed in a different area of the same shoulder than the primary procedure. There are three exceptions to this rule. Per National Correct Coding Initiative (NCCI) edit guidelines, extensive debridement (CPT® 29823) performed in a different area of the same shoulder with any of the following arthroscopic shoulder procedures may be reported separately:#N#29824 Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure)#N#29827 with rotator cuff repair#N#29828 biceps tenodesis#N#Example: When an arthroscopic rotator cuff repair with debridement of the biceps tendon and debridement of the labrum is performed, you may report 29827 and 29823 because the bundling edit is removed from this code combination.#N#When an arthroscopic repair of a superior labrum anterior and posterior (SLAP) lesion is performed with debridement of the labrum and biceps tendon on the same shoulder, however, you may only report CPT® 29807 Arthroscopy, shoulder, surgical; repair of SLAP lesion. Per NCCI guidelines, the debridement (29823) is considered included in the primary procedure when performed on the same shoulder.
Type III: A bucket-handle tear of the labrum, where the torn part of the labrum hangs into the joint. Type IV: The torn labrum extends all the way into the biceps tendon. Check the documentation to identify where on the labrum the surgery was performed. Many surgeons refer to “clock” positions.
Three areas generally recognized as part of the shoulder are the: 1 Glenohumeral joint, 2 Acromioclavicular joint, and 3 Subacromial bursal space.
Shoulder Anatomy. Three areas generally recognized as part of the shoulder are the: Glenohumeral joint, Acromioclavicular joint, and. Subacromial bursal space. The Centers for Medicare & Medicaid Services (CMS), however, considers the shoulder to be a single anatomic structure.
Some arthroscopic procedures require immediate conversion to an open surgical procedure. When this happens, you may only report the open surgical procedure. However, you may append modifier 22 to the open procedure code to support the additional work performed arthroscopically.
The shoulder is a complex joint, and proper coding for shoulder procedures requires a strong foundation of knowledge in anatomy and physiology. Shoulder arthroscopy codes particularly can be confusing as the guidelines for arthroscopic shoulder surgeries have changed considerably in the last decade. Here are some essential points to understand about arthroscopic shoulder surgery coding and documentation.