29827-LT Arthroscopy, shoulder, surgical; with rotator cuff repair-Left side 29823-59-LT Arthroscopy, shoulder, surgical; debridement, extensive-Distinct procedural service 29819-59-LT Arthroscopy, shoulder, surgical; with removal of loose body or foreign body
Coding Debridement 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.
This means you may not use a modifier to bypass the bundling edits in place for shoulder arthroscopy procedures unless the services are performed on separate shoulders. CPT® code 29822 Arthroscopy, shoulder, surgical; debridement, limited includes debridement of soft or hard tissue.
Arthroscopic SLAP debridement is reported from the arthroscopic shoulder debridement codes pending other debridements performed during the operative session. These debridement codes may be considered inclusive into other surgical procedures performed during the same operative session. 29806 Arthroscopic surgical shoulder; capsulorrhaphy
Presence of left artificial shoulder joint. Z96.612 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2018/2019 edition of ICD-10-CM Z96.612 became effective on October 1, 2018. This is the American ICD-10-CM version of Z96.612 - other international versions of ICD-10 Z96.612 may differ.
In ICD-10-PCS, arthroscopy goes to the root operation “inspection,” which is defined as visually and/or manually exploring a body part. Therefore, an arthroscopy of the right knee is classified to code 0SJC4ZZ, and arthroscopy of the left knee is classified to code 0SJD4ZZ.
CPT® code 29822 Arthroscopy, shoulder, surgical; debridement, limited includes debridement of soft or hard tissue.
2022 ICD-10-PCS Procedure Code 0RSJ0ZZ: Reposition Right Shoulder Joint, Open Approach.
Aftercare following explantation of shoulder joint prosthesis. Z47. 31 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z47.
Extensive Debridement Shoulder is a procedure used to remove debris and damaged tissue in the shoulder joint. This procedure is performed as minimally invasive as possible by using a very small camera called an arthroscope.
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.
The Current Procedural Terminology (CPT®) code 23700 as maintained by American Medical Association, is a medical procedural code under the range - Manipulation Procedures on the Shoulder.
Arthroscopic capsular release and manipulation under anesthesia (MUA) are the surgical procedures performed to treat the frozen shoulder. Frozen shoulder, also called adhesive capsulitis is a condition characterized by pain and loss of motion in shoulder joint.
CPT code 29826—Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (List separately in addition to code for primary procedure)—was revised in 2012.
Use Z codes to code for surgical aftercare. Z47. 89, Encounter for other orthopedic aftercare, and.
ICD-10-CM Code for Encounter for other orthopedic aftercare Z47. 89.
Presence of left artificial shoulder joint Z96. 612 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM Z96. 612 became effective on October 1, 2021.
Code 29822 covers limited debridement of soft or hard tissue and should be used for limited labral debridement, cuff debridement, or the removal of degenerative cartilage and osteophytes. Code 29823 should be used only for extensive debridement of soft or hard tissue.
Parenthetical instruction in CPT also states that code 29826 is to be used in conjunction with codes 29806-29825, 29827, and 29828. There are no existing National Correct Coding Initiative (NCCI) edits in place for these code pairs which would preclude one from reporting these codes together.
CPT® 23430 in section: Repair, Revision, and/or Reconstruction Procedures on the Shoulder.
121 for Complete rotator cuff tear or rupture of right shoulder, not specified as traumatic is a medical classification as listed by WHO under the range - Soft tissue disorders .
The AHA Coding Clinic for ICD-9-CM has provided much guidance on when to code ICD-9 Code 86.22, Excisional debridement of wound, infection or burn. The information from 1988 to 2005 specifies that the code applies to the surgical removal or cutting away rather than scrubbing, scraping, brushing, washing or snipping away bits of tissue with scissors. Therefore, applying the guidance, one would be geared towards reporting an excisional debridement when a portion of a body part is cut out or off using a sharp instrument, such as a scalpel, wire, scissors, a bone saw, electrocautery tip or a sharp curette provided the documentation in the medical record also supported the procedure. The other important thing to remember, which most forget, is that the coding clinic provided guidance in cutting tissue outside or beyond the wound margin. The first quarter 2004 Coding Clinic further defined excisional debridement to involve cutting outside or beyond the wound margin in removing devitalized tissue. Documentation should clearly indicate that the procedure involves cutting outside or beyond the wound margin. If in doubt, look for a specimen being sent to the lab.
Also remember that excisional debridement is not necessarily exclusive to the operating room. It can be done at bedside, or in the emergency department. From a coding perspective as to which one, excisional vs. non-excisional, may apply, ponder on the inpatient example in which a patient is found to have a decubitus ulcer requiring and excisional debridement. This patient is likely to require a longer hospital stay than one who only needs a round of antibiotics and Silvadene with regular dressing changes.
Example #2: Arthroscopic Rotator Cuff Repair, Distal Claviculectomy, Debridement of the Labrum, Glenoid Bone and Biceps Tendon. Codes are: 29827, 29824, and 29823. There are three separate and discrete structures debrided separately from the rotator cuff repair and distal claviculectomy.
Coders should not be assigning the code based on the provider’s statement of extensive debridement.
For example, a bursal-sided supraspinatus tear cannot be counted as a debrided structure if the supraspinatus is repaired in the same session.”
Coders must continue to review the detailed op note to verify the structures debrided vs. the structures repaired/treated with another surgical CPT code and assign the debridement code based on the number of discrete structures debrided. Structures should not be counted towards debridement if another procedure is performed on that same structure in the same operative session.
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.
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.
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.
Type IV: The torn labrum extends all the way into the biceps tendon
A SLAP injury is a specific kind of labral tear in which the front (anterior) and back (posterior) areas of the labrum are torn where it attaches to the biceps tendon.
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.
We closed all incisions with 4-0 Monocryl suture in the subcuticular layer and used Dermabond to approximate the skin. A sterile dressing was then placed and the drapes were removed.
8. Glenohumeral joint without any evidence of chondrosis.
Per CPT these two can be billed together no problem. So it comes down to payor/carrier interpretation. I would have chosen these 2 codes also, but if you're billing this case to Medicare or another carrier that uses CCI edits...you're looking at only billing 29822. If it's a commercial carrier that does not use CCI edits...bill out both CPT's.
Code 29826 - Subacromial Decompression is now an add on code. I was thinking 29822 & 29826 would cover this procedure. However my coding software tells me 29822 is considered to be part of 29826. Any ideas on how I should code this?
Arthroscopic SLAP debridement is reported from the arthroscopic shoulder debridement codes pending other debridements performed during the operative session. These debridement codes may be considered inclusive into other surgical procedures performed during the same operative session.
For example, the Medicare allowable for a shoulder arthroscopy with lysis and resection of adhesions (CPT 29825) is $593 while the average commercial payment for the procedure in $1,350 — a payment of more than double the Medicare allowable.
The ASC’s basis for appeal was essentially the same at all levels: “code 29999 is used for arthroscopic biceps tenotomy, as there is no more specific code.In its re determination notice, WPS explained:
Report CPT 29806 for surgical capsular repairs when they’re performed arthroscopically. Rather than reporting CPT code 29806 for arthroscopic thermal capsulorrhaphy, use the unlisted code 29999 versus S2300 for arthroscopic thermal capsulorrhaphy, pending carrier guidelines.
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.
29826 – Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromialligament (ie, arch) release, when performed (List separately in addition to code for primary procedure) average fee amount – $150 – $200
Use Procedure code series 23410 to 23412 to report mini open rotator cuff tear repairs, with code selection determined by acute versus chronic conditions. While Procedure provides a parenthetical statement under 29827 (Arthroscopy, shoulder, surgical; with rotator cuff repair) directing the Procedure user to report 23412 for mini open rotator cuff repair, you still need to determine the final code selection based on the acute versus chronic condition. Recall that Procedure code verbiage in 23410 to 23420 is specific to an acute versus chronic condition.