Unspecified rotator cuff tear or rupture of right shoulder, not specified as traumatic. This is the American ICD-10-CM version of M75.101 - other international versions of ICD-10 M75.101 may differ.
If he debrides the labrum and stump arthroscopically and then repairs the rotator cuff open, I code 23412 and 29822. If he does same arthro procedure but his open procedure is tenodesis, I only code 23440 b/c the debridement was on same area that is being repaired.
For example, if a subacromial decompression is performed alone, which usually involves debridement of soft tissues or bone removal, then report code 29822 instead of +29826. Likewise, if there is extensive work done in the removal of the soft tissue and bone, then report 29823 instead of +29826.
Use CPT code series 23410 to 23412 to report mini open rotator cuff tear repairs, with code selection determined by acute versus chronic conditions.
Shoulder arthroscopy and decompression is a procedure used to treat shoulder impingement, which occurs when the tendons in the rotator cuff muscles are squeezed or pinched by the surrounding structures in the shoulder.
Subacromial Decompression is an arthroscopic procedure designed to release the tight ligament of the coracoacromial arch and to shave away some of the under surface of the acromion. This raises the roof of the shoulder, allowing more room for the rotator cuff tendons to move underneath.
Subacromial decompression is an operation on your shoulder to treat a condition called shoulder impingement, which causes pain when you lift your arm. It's usually done through keyhole surgery (arthroscopy). The operation is sometimes called acromioplasty.
29826CPT code 29826 (arthroscopic subacromial decompression), may be reported in conjunction with an open rotator cuff repair (23412) and arthroscopic distal claviculectomy (29824).
Shoulder subacromial decompression (also called acromioplasty) is a surgical procedure to treat shoulder impingement, a common condition that causes weakness in your shoulder and pain when you raise your arm above your head. It is performed using keyhole surgery.
Rotator cuff repair is surgery to repair a torn tendon in the shoulder. The procedure can be done with a large (open) incision or with shoulder arthroscopy, which uses smaller incisions.
The study noted that subacromial decompression surgery provided no important benefit compared with placebo surgery or exercise therapy. In particular, they found that surgery did not provide any additional benefit for pain, function, and quality of life at the 6- and 12-month mark after surgery.
The subacromial bursa is located below a part of the shoulder blade called the acromion (hence the name “subacromial”). The acromion is the topmost part of the shoulder blade. It forms the bony top of the outer shoulder.
CPT 29827When a surgeon performs an arthroscopic rotator cuff repair, report CPT 29827 regardless of whether the condition is acute versus chronic. The operative report should specify an acute versus chronic condition.
You can bill 29827 & 29828 together as there is no edit that prohibits it. In 2017 CMS stated in the NCCI Surgical Policy Manual that the shoulder is considered "one anatomical" unit or location. As such, when billing Medicare or any insurance that follows their rules, you cannot bill any coding pair that hits an edit.
If the repair is a SLAP, you'd code work done on the upper half of the labrum as 29807 (Arthroscopy, shoulder, surgical; repair of SLAP lesion). If the repair was in the lower half of the labrum, you'd use instead code 29806 (Arthroscopy, shoulder, surgical; capsulorraphy).
For example, while CPT 29822 normally bundles into CPT code 29824 (Arthroscopic, shoulder, surgical, distal claviculectomy), both may be reported if the limited debridement is performed on other areas of the shoulder unrelated to the area/work performed to complete the arthroscopic, distal claviculectomy.
Yes, it will depend on the insurance what you bill#N#So far BX is not on board with 29823.#N#If it's not BX, I would bill 29823 instead of 29826 since it has more RVU for your doc.
In it she states that the rotator cuff is one anatomical unit (CMS incorrectly states that the entire shoulder is one anatomical unit) and due to that you cannot report both an open and arthroscopic code for RTC repair. It's one or the other, but not both.
The 2017 CMS NCCI Surgical Policy Manual states that limited debridement is included with all shoulder procedures. In other words, code 29822 must be billed on its own. Margie Scalley Vaught from the education department of AAOS has written a couple of shoulder surgery articles in our coding magazine in the last couple of years. In it she states that the rotator cuff is one anatomical unit (CMS incorrectly states that the entire shoulder is one anatomical unit) and due to that you cannot report both an open and arthroscopic code for RTC repair. It's one or the other, but not both. They July 2017 of Healthcare Business Monthly has a really good article. March of 2016 also has a good one on shoulder coding too.
Debridement can't be part of a restorative procedure. Any debridement that is in preparation for a restorative procedure cannot be counted towards 29823. Let's look at the biceps tenodesis: Performed tenotomy, debrided the stump, debrided the bone where the suture was placed.
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.