Trends for Shoulder Coding in 2018

While there may not have been many CPT code changes to the arthroscopy codes in recent years, Medicare and commercial insurance guidelines and policies continue changing due to the large amount of money insurance pays out for shoulder arthroscopy. It can be tough to keep up with these ever-changing policies.

One goal you should have is to minimize denials for arthroscopic procedures by applying the current coding guidelines and edits in place – not only for Medicare but any insurance that follows Medicare’s lead. Understanding the latest coding trends in commercial insurance policies for some major carriers can put you in the know on their processing of your shoulder arthroscopy claims.

Don’t SLAP Yourself

Procedures to repair superior labral anterior to posterior (SLAP) tears are some of the most common things you’ll have to code:

• In a Type I SLAP lesion, the labrum is frayed and degenerated but remains intact to the glenoid, and the biceps anchor is also intact.
• A Type II SLAP lesion involves detachment of the labrum and biceps anchor from the superior glenoid.
• In a Type III SLAP lesion, the labrum is torn away, but the biceps anchor and remaining labrum are still attached to the glenoid.
• Type IV SLAP lesions involve bucket-handle tears of the labrum that extend into the biceps anchor.

Common coding for SLAP lesions include 29822 for limited debridement in Type I or III SLAP. For an open procedure, you need to see the specific open shoulder procedure performed, either 29807 for SLAP repair of Types II and IV, or 29806 for capsulorrhaphy. For open procedures, see 23450 through 23466, and note that these should only be billed if there is a defect in a different area.

Arthroscopic Shoulder Synovectomy Woes

The CPT codes for arthroscopic shoulder synovectomy can also get knotty. Use 29820 for partial synovectomy in the front or back of the shoulder plica with limited synovitis, and 29821 for complete synovectomy in the front and back of shoulder related to rheumatoid arthritis, villonodular synovitis, or the entire intra-articular synovium.

Arthroscopic Shoulder Debridement

This procedure involves CPT codes 29822 for limited debridement and 29823 for extensive debridement.

In limited debridement, the front or back of the shoulder receives limited labral debridement, and the rotator cuff, cartilage or osteophytes are involved. Extensive debridement involves the front and back of shoulder chondroplasty of the humeral head or glenoid with osteophytes, labrum, subcapsularis or supraspinatus.

Also note that loose or foreign body removal can only be billed when a separate incision due to size is required.

Other Common Shoulder Codes

You’ll also likely run across the following:

• 29824 Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure)
• 29825 Arthroscopy, shoulder, surgical; with lysis and resection of adhesions, with or without manipulation
• 29827 Arthroscopy, shoulder, surgical; with rotator cuff repair
• 29828 Arthroscopy, shoulder, surgical; biceps tenodesis

Related Reading : What’s New For Shoulder Surgical Procedure Coding in 2020

NCCI Policy Manual Updates

In 2017, CMS updated its NCCI Policy Manual concerning shoulder coding. The agency says it “considers the shoulder to be a single anatomic structure” and notes that in a CCI edit involving two shoulder arthroscopy codes, coders should never override the edit for services on the ipsilateral, or same-side, shoulder. “This type of edit may be bypassed with an NCCI-associated modifier only if the two procedures are performed on contralateral shoulders,” says the manual, which also notes there are three exceptions.

“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,” continues the manual. “With three exceptions, shoulder arthroscopy procedures include extensive debridement (e.g., CPT code 29823) even if the extensive debridement is performed in a different area of the same shoulder than the other procedure.”

Those three exceptions are CPT codes:

• 29824: Arthroscopic claviculectomy including distal articular surface
• 29827: Arthroscopic rotator cuff repair
• 29828: Biceps tenodesis may be reported separately with 29823 if extensive debridement is performed in a different area of the same shoulder

Finally, states the manual, “with limited exceptions open or arthroscopic procedures performed on a joint include debridement (open or arthroscopic) if performed. A debridement code may be reported with a joint procedure code only if the debridement is performed on a different joint or at a site unrelated to the joint.” The manual then refers to Section E (Arthroscopy) for further discussion of exceptions.

The 411 on 29826 and Tenotomy

You might remember in 2012, CPT code 29826 for arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (or arch) release became an add-on code. That meant you could no longer report 29826 as the standalone code and you were required to list it separately in addition to the code for a primary procedure. So you must report 29822 for limited or 29823 for extensive, depending on the extent of the debridement.

Also keep in mind that arthroscopic biceps tenotomy can’t be reported if performed for visualization, or with a biceps tenodesis code, but it can be reported with 29999 and you can compare it to an open tenotomy.

Help for Shoulder Coders

Orthopedics coding expert Margie Vaught addresses these difficult coding issues for shoulders and more in an audio conference for ProfEdOnDemand, “Understanding Coding Changes for Total Hips & Total Knees With the New Spacer Codes”  Margie will bring you up-to-date with the most current coding trends for arthroscopy of the shoulder, hip, knee, ankle and wrist, and you’ll learn the latest information on coding and reimbursement for arthroscopic procedures in order to maximize reimbursement for your providers. She also makes valuable suggestions on dealing with pre-authorizations and the codes that should be included for different areas of the body.

Additional reading : Get to know Modifier 59, when to use Code 29826, and all about Debridement