2023 Shoulder coding CPT code updates you should be aware of. For 2023 in general, there were 225 new CPT codes added, 75 deleted and 93 revised.
Under shoulder procedures in 2023, there are two new CPT codes that are important to look at.
New code 0717T Autologous adipose-derived regenerative cell (ADRC) therapy for partial thickness rotator cuff tear; adipose tissue harvesting, isolation and preparation of harvested cells, including incubation with cell dissociation enzymes, filtration, washing, and concentration of ADRCs and new code 0718T injection into supraspinatus tendon including ultrasound guidance, unilateral. Note that one code is for the prep and the other for the injection. It helps to repair the supraspinatus tendon which is part of the rotator cuff.
An Overview of the 2021 Arthroscopic Shoulder Debridement CPT Code Revisions
Have you heard about the updated AMA CPT Code revisions for arthroscopic shoulder debridement codes 29822 and 29823? The revisions were made to provide clearer definitions of limited and extensive debridement. This was necessary because coders and providers faced difficulty determining the difference between these two types of debridement. In this article, we will take a closer look at the updated CPT codes.
CPT Code 29822 – Arthroscopy, shoulder, surgical; debridement, limited, one or two discrete structures
This code covers the debridement of one or two discrete structures such as 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, and foreign body(ies).
CPT Code 29823 – Arthroscopy, shoulder, surgical; debridement, extensive, three or more discrete structures
This code covers the debridement of three or more discrete structures such as 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, and foreign body(ies).
What is the difference between CPT 29822 and 29823?
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.
Understanding the New Descriptors
While the revised descriptors appear straightforward, the difficulty lies in determining whether additional procedures were performed on the same shoulder during the surgery. According to CPT Assistant December 2020 pg 8, structures debrided as part of another procedure reported for the same session cannot be counted to meet the criteria of the debridement code. For example, a bursal-sided supraspinatus tear cannot be counted as a debrided structure if the supraspinatus is repaired during the same session.
The AMA hopes that by specifying both the number and names of anatomical structures involved in shoulder debridement, coders and providers can more accurately select the appropriate code. This will be based on the medical documentation in the operative report. Coders should not assign the code based solely on the provider’s statement of extensive debridement.
Debridement and Structure Repairs
Coders must carefully review the detailed operative note to verify the structures that were debrided versus those that were repaired or treated with another surgical CPT code. They should also assign the debridement code based on the number of discrete structures that were debrided. Coders should not count structures towards debridement if providers performed another procedure on that same structure during the same operative session.
Possible Effects on Coding
This change may cause coders to downgrade some surgeries to code 29822 for limited debridement. Officials remind coders to follow NCCI edits for code 29822 if it was performed on the same shoulder. According to the NCCI edits (Chapter 4), 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. An NCCI PTP edit code pair consisting of two codes describing two shoulder arthroscopy procedures shall not be bypassed with an NCCI PTP-associated modifier when the two procedures are performed on the ipsilateral shoulder. This type of edit may be bypassed with an NCCI PTP-associated modifier only if the two procedures are performed on contralateral shoulders.
EXAMPLES OF THE REVISED CODES Let’s look at some examples:
Example #1: Arthroscopic Rotator Cuff Repair, Biceps Tenodesis, Subacromial Decompression, Debridement of the Labrum and Biceps Tendon. Codes are: 29827, 29828, and 29826. Practitioners would not record any codes for the Labrum/Biceps debridement as it’s only one discrete site. Coders would bundle code 29822 per the NCCI edits. Coders would not count the biceps debridement towards the debridement. This is because the provider performed a repair of the same structure.
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.
Helpful Download: MUSCULOSKELETAL SYSTEM CPT CODES 20000-29999 FOR MEDICARE NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL – CHAPTER 4 SURGERY
REFERENCE
(Websites referred to for the ‘2023 Shoulder coding CPT code updates’ article)
A Look at Arthroscopic Shoulder Debridement CPT Codes 29822 & 29823
