As per CCI edits, there is no guidelines which says 29806 and 29827 cannot billed together. There are some payers who deny 29806/29827 combination just because of same anatomical location and structure.
Can 29806 and 29827 be billed together?
As per CCI edits, there is no guidelines which says 29806 and 29827 cannot billed together. There are some payers who deny 29806/29827 combination just because of same anatomical location and structure.
What is the difference between CPT code 29822 and 29823?
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.
What is the difference between 29806 and 29807 shoulder surgery?
When 29806 Arthroscopy, shoulder, surgical; capsulorrhaphy and 29807 were developed, William Beach, MD, of the AAOS Coding Committee stated the goal was to divide the labrum in half (29807 upper half, 29806 lower half).
Should I Bill 29822 with a modifier?
The only time you should bill 29822 ( Arthroscopy, shoulder, surgical; with debridement, limited) separately with a modifier is when it’s performed on the contralateral shoulder — the shoulder on the opposite side of the body from where the other procedure takes place.
Can 29827 and 29806 be billed together?
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.
Can CPT code 29824 and 29827 be billed together?
CPT codes 29824 (arthroscopic claviculectomy including distal articular surface), 29827 (arthroscopic rotator cuff repair), and 29828 (biceps tenodesis) may be reported separately with CPT code 29823 if the extensive debridement is performed in a different area of the same shoulder.”
Can CPT code 29827 and 29807 be billed together?
In this situation, coding 29827 (arthroscopic rotator cuff repair) with 29819-59 is allowed. Also, code 29807 arthroscopic repair of a superior labral anterior posterior (SLAP) lesion may also be billed with the loose body code (29819-59).
What does CPT 29827 include?
CPT® Code 29827 in section: Arthroscopy, shoulder, surgical.
Does 29827 include graft?
- application of graft is included in the procedure so only code the RC procedure (23410, 23412, 23420, 29827) or arthroplasty (23470, 23472) alone.
Does 29827 include debridement?
For example, when debriding the articular and bursal side of the rotator cuff and then going on to repair the cuff, only 29827 would be reported. 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).
What is the difference between 29806 and 29807?
Error #3: Unbundling 29806 and 29807 for SLAP 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).
Can 29827 and 29825 be billed together?
CPT code 29825 describes arthroscopic lysis of adhesions; CPT code 29827 describes an arthroscopic rotator cuff repair. According to the AAOS Global Service Data Guide, these two procedures are exclusive to each other.
Is a slap tear the same as a labrum tear?
Superior Labrum, Anterior to Posterior tears (SLAP tears), also known as labrum tears, represent 4% to 8% of all shoulder injuries. The L in SLAP refers to your glenoid labrum. Your labrum plays two important roles in keeping your shoulder functioning and pain free.
Can 29827 and 29826 be billed together?
yes, you can 29827, shoulder scope w/ RTC, is listed as one of the primary procedure codes you can add-on the 29826, scope SAD.
How do you bill a shoulder arthroscopy?
This procedure is reported with CPT® +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).
What is the difference between limited and extensive debridement?
As you can see from the code descriptions, a limited debridement is now defined as 1 or 2 discrete structures and extensive requires debridement of 3 or more discrete structures. In the past, a surgeon could document extensive debridement of one structure and have CPT 29823 reported. However, this has changed for 2021.
What is the CPT code for shoulder surgery?
To make sure you recoup proper reimbursement, let’s address CPT® codes 29821, 29822, 29823, 29824, 29826, 29827, 29828, 29806, and 29807, as well as arthroscopic superior capsular reconstruction (ASCR).
What is the CPT code for a rotator cuff repair?
Whether one or all four components that make up the rotator cuff (supraspinatus, infraspinatus, teres minor, and subscapularis (SITS)) are repaired in a single shoulder, report a single unit of 29827.#N#If the surgeon begins a rotator cuff repair arthroscopically, but converts to a mini-open approach to finish, report only the appropriate “open” CPT® code (23410 Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute or 23412 Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; chronic). You may report 23410/23412 with modifier 22 Unusual procedural service appended to account for the arthroscopic work done prior to the open portion. Do not report both the open and arthroscopic codes because the work was in the same anatomic location and same session, which does not support the definition of modifier 59 Distinct procedural service.#N#ASCR is a newer arthroscopic procedure for an irreparable rotator cuff. This procedure involves placement of a fascia lata or similar graft that is attached to the top of the glenoid and greater tuberosity of the humerus. This is not a side to side or reattachment of the cuff tissue; it involves placement of graft material, which makes it a reconstruction, not a repair. There is no CPT® code to describe this procedure. Per the AMA Coding Committee, CPT® guidelines, and April 2017 CPT® Assistant, ASCR may be reported as an unlisted procedure (29999 Unlisted procedure, arthroscopy ). It’s inappropriate to report ASCR using 29827 (either with or without modifier 22).#N#Code 29828 Arthroscopy, shoulder, surgical; biceps tenodesis represents an arthroscopic biceps tenodesis. A mini-open biceps tenodesis should be coded as open with 23430 Tenodesis of long tendon of biceps.#N#Prior to biceps tenodesis, the surgeon often debrides and cuts the biceps (tenotomy). This is inclusive to the tenodesis, so do not report it separately.#N#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.
What is the code for bicep tenodesis?
A mini-open biceps tenodesis should be coded as open with 23430 Tenodes is of long tendon of biceps. Prior to biceps tenodesis, the surgeon often debrides and cuts the biceps (tenotomy).
What is the code for arthroscopic debridement?
The AAOS, the Arthroscopy Association of North America, and the AMA advise to report this scenario with an arthroscopic debridement code, 29822 (soft tissue only) or 29823 (bone and soft tissue).
Is 29824 a mistake?
Many offices have stopped reporting 29824 unless there is a documented reference to size, but this is a mistake. If there is a question as to whether a procedure was done, query the surgeon. Some payers have placed size references in their own internal policies, but that is a payer-contracted issue.
Can I use 29826 with 29822?
Medicare agrees, and allows +29826 to be reported with all other shoulder arthro scopy codes, including 29822 and 29823. Be sure there is clear documentation that bony work was performed on the acromion to support +29826.
Is 29824 a clinical example?
The AMA provided a clinical example when 29824 was first developed — but it was strictly an example, and not all-inclusive of the requirements for reporting. For years, AAOS referenced size in their CodeX and Global Service Data books to be sure surgeons were not reporting 29824 for removing only a spur.
What is CPT code 29823?
Effective July 1, 2016, NCCI no longer bundles CPT® code 29823 Arthroscopy, shoulder, surgical; debridement, extensive with 29828 Arthroscopy, shoulder, surgical; biceps tenodesis; 29827 Arthroscopy, shoulder, surgical; with rotator cuff repair; or 29824 Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure). That means a modifier is no longer needed when reporting these code pairs during the same operative session. Note, however, that this change affects only the modifier status indicator, not the guidelines in the 2016 NCCI Policy Manual for Medicare Services.#N#Chapter 4 guidelines continue to specify, “With the exception of the knee joint, arthroscopic debridement should not be reported separately with a surgical arthroscopy procedure when performed on the same joint at the same patient encounter.” By this logic, arthroscopic debridement of the shoulder (29823) is included in all other shoulder arthroscopy codes. Based on the Chapter 4 guidelines, you (still) should not report 29823 with 29828, 29827, or 29824 to Medicare.#N#Many private payers also follow NCCI edits and guidelines. Reference your contracts for their stance. Until the NCCI guidelines are changed, your payer may not reimburse 29823 with a biceps tenodesis (29828), rotator cuff repair (29827), or Mumford procedure (29824). NCCI guidelines are not updated unless requested, and revisions normally take place by Dec. 1, effective the following year. Hopefully, AAOS will contact the Centers for Medicare & Medicaid Services (CMS) and request a change in the guidelines, prior to#N#the deadline.#N#Even though the modifier status indicator has changed for these code pairs, keep an eye on your explanation of benefits (EOBs). If you find that payers continue to deny claims for 29823 with 29824, 29827, or 29828, you may want to appeal, citing the NCCI status indicator effective July 1, 2016. Be prepared for a rebuttal if the payer, in turn, cites the contradictory NCCI guidelines.
What is the code for Medicare?
For Medicare patients — and any other patients covered under federally-funded healthcare programs, such as Medicaid, federal BlueCross® BlueShield®, CHAMPVA, TRICARE®, and any other healthcare program provided to federal employees — code combinations 29806/29827 and 23472/23430 will be denied.
When are NCCI guidelines updated?
NCCI guidelines are not updated unless requested, and revisions normally take place by Dec. 1, effective the following year. Hopefully, AAOS will contact the Centers for Medicare & Medicaid Services (CMS) and request a change in the guidelines, prior to. the deadline.
Does a modifier need to be reported during the same operative session?
That means a modifier is no longer needed when reporting these code pairs during the same operative session. Note, however, that this change affects only the modifier status indicator, not the guidelines in the 2016 NCCI Policy Manual for Medicare Services.
Is 29823 a code for arthroscopic debridement?
By this logic, arthroscopic debridement of the shoulder (29823) is included in all other shoulder arthroscopy codes. Based on the Chapter 4 guidelines, you (still) should not report 29823 with 29828, 29827, or 29824 to Medicare. Many private payers also follow NCCI edits and guidelines. Reference your contracts for their stance.
Appeal Letter Templates
Our appeal letter templates may be used to appeal inappropriate denials for shoulder debridement, CPT codes 29823 and 29826 reported in conjunction with codes 29824, 29827, and 29828. The letter offers the framework needed to support appeals for denied procedures and may be altered to fit the specific situation.
Coding Resources from AAOS Global Service Data Guide for Orthopaedic Surgery
Find below resources from the 2020 AAOS Global Service Data Guide that support reporting shoulder arthroscopy procedure codes separately. Each page is in PDF format for easy download and/or print.
What is the code for shoulder surgery?
There is only one diagnostic shoulder code: 29805 ( Arthroscopy, shoulder, diagnostic, with or without synovial biopsy ( separate procedure ). The rest of the arthroscopy codes are surgical and include the diagnostic arthroscopy. Only bill 29805 when the diagnostic is the only procedure that’s done. When a procedure begins diagnostically and becomes a surgery, only code the surgery.
What is the code for a labrum repair?
If the repair was in the lower half of the labrum, you’d use instead code 29806 ( Arthroscopy, shoulder, surgical; capsulorraphy ). Now, if the surgeon works on both the upper and lower labrum, you cannot simply unbundle and code both 29806 and 29807.
When to use modifier 59?
You may use modifier 59 to unbundle these codes when the surgeon performs a capsulorraphy that is unrelated to the labrum tear. You must have documentation that substantiates that the capsular defect is unrelated to the labrum tear. Caution: The surgeon may repair the labrum by attaching it to the capsule.
What modifier is used to indicate arthroscopic work?
The surgeon performed the procedures on the same anatomic location during the same surgical session. Instead, you can append modifier 22 ( Increased procedural service) to the open procedure code to indicate the initial arthroscopic work.
What is the code for a glenoid surgery?
The code for the open procedure is 23120 ; use 29824 for an arthroscopic procedure. Procedures to correct instability. Instability is usually caused by either a defect at the insertion of the capsule into the rim of the glenoid (Bankhart lesion) or a generally loose capsule.
What is the code for a slap lesion?
Adding code 29806 (Arthroscopy, shoulder, surgical, capsulorrhaphy) for repair of a SLAP lesion is never appropriate unless there is a capsular defect in an area different than the SLAP.
What is the wording for a synovectomy?
Removal of loose body/bodies is included in the synovectomy and debridement codes unless the loose or foreign body is large enough to require a separate incision to remove it. The wording in the GSD is “arthroscopic removal of loose or foreign bodies greater than 5mm and/or through a separate incision.”.
What is the code for thermal capsulorrhaphy?
There is no code for thermal capsulorrhaphy. If it is the only procedure performed, use code 29999 (Unlisted procedure, arthroscopy). This procedure is performed for instability and if it is used as an adjunct to other capsular procedures, coding 29999-51 is appropriate.
What is the code for arthroscopic shoulder biopsy?
As with all arthroscopic procedures, code 29805 (Arthroscopy, shoulder, diagnostic with or without synovial biopsy) is reported only when nothing else is done. If any other code is used, it is not appropriate to report the diagnostic code, even if the diagnostic arthro- scopy is followed by an open procedure.
Is there confusion about shoulder procedures?
There has been confusion about how to code shoulder procedures, especially relating to arthroscopic procedures. In the last few years, a number of new arthroscopic shoulder CPT codes have been added. However, some aspects of the CPT coding system itself remain confusing, a problem the AAOS CPT Committee is attempting to rectify. Until the matter is resolved, here are some suggestions on how to code shoulder procedures.
Can you code acromionectomy separately?
It is appropriate to code separately for an acromionectomy that is performed in conjunction with an open or arthroscopic rotator cuff repair. However, this cannot be done with code 23240 where the descriptor states, “includes acromionectomy.”.
What is CPT code 29822?
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.
Does NCCI pay for modifiers?
With all NCCI edits with indicator of 1 (modifier bypass eligible) if it meets criteria for separate reimbursement then yes it will pay separately w/ modifier. You cant just automatically attach a NCCI bypassing modifier.
What is 29826 code?
What to code when only an Acromioplasty is performed alone (29826) 29826 is defined as an 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).
How much does Medicare pay for shoulder arthroscopy?
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.
Does 29807 reimburse for a SLAP?
If 29807 is a SLAP type 1 or 3 lesion do not append modifier 59 to 29807 and 29807 does not reimburse separately with 29806. If 29807 is performed on one shoulder and 29806 is performed on the opposite shoulder append modifier 59 to one of these procedures and both procedures reimburse separately.
