If you’re running into problems when reporting CPT code 29826 for acromioplasty, you’re not alone. Follow these expert tips to ensure that you’re coding properly and avoid unnecessary claim denials.
Crucial: The most important thing to remember when reporting code 29826 is that it’s not a stand-alone code, even if some payers still have it as a “real” code and not an add-on, according to orthopedics coding expert Margie Scalley Vaught in her webinar, “Perfect Your Coding of Arthroscopic Procedures – Shoulders/Wrists/Hips/Knees/Ankles.” You can report 29826 only with other scope procedures.
Understand The Coding Guidelines
If acromioplasty is the only procedure performed, you would report CPT code 29822 — Arthroscopy, shoulder, surgical; debridement, limited, or 29823 — …debridement, extensive. In this case, you would not report 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).
Rules: The American Academy/Association of Orthopaedic Surgeons (AAOS) states:
“CPT code 29826 should not be reported with any procedure other than those identified as appropriate parent codes. It is not an add-on code to CPT code 23410 or 23412, and an unlisted code may not be reported to reflect this work. Instead, append modifier 22 or report 29822 or 29823 (limited or extensive debridement) as appropriate.”
If the surgeon performs an arthroscopic subacromial decompression or acromioplasty but does not perform any other procedure in the same operative setting, you should report CPT code 29822 or 29823, depending on the extent of the work involved, according to Precision Practice Management. But if the surgeon performs the decompression or acromioplasty together with an arthroscopic rotator cuff repair, you would bill CPT code 29827 and add on 29826.
Learn From This Example
Scenario: The surgeon performs a right arthroscopic rotator cuff repair with a distal claviculectomy, acromioplasty, and debridement of the labrum. The surgeon performed a subacromial decompression and 1 cm is removed from the distal clavicle.
Wrong way: For this scenario, you might want to report CPT codes 29827 RT, 29824 RT, add-on 29826 RT, and 29822 RT with modifier 59, according to Outsource Strategies International. But according to the National Correct Coding Initiative (NCCI) edits, 29822 bundles into 29827 and 29824 – and because this is the same shoulder, using a modifier to bypass the bundling edit is inappropriate.
Right way: For this type of case, you should:
- Report 29824 if the surgeon performed the procedure on the shoulder arthroscopically, performed on the distal clavicle, and removed approximately 1 cm from the distal clavicle.
- Report 29822 (limited debridement) if the surgeon created a 1 cm space by removing 7 cm from the distal clavicle and 3 mm from the acromion, because the documentation does not meet the minimum requirements for the distal claviculectomy or the acromioplasty.
- Report 29822 and 29826 if the 3 mm removed from the acromion is a true acromioplasty, which is achieved when the surgeon converts the acromion to a type I morphology with a subacromial decompression. The 7 mm does not meet the claviculectomy requirements and the documentation must support both services.
Ensure Documentation Names The Tool Used
What’s more: Your documentation is also under heavy scrutiny for CPT code 29826. The CPT example of supporting documentation for 29826 is as follows:
“The subacromial bursa is accessed via the posterior portal, which reveals some fraying of the coracoacromial ligament. A lateral arthroscopic portal is developed and bursal tissue and the bursal side cuff are debrided for visualization. The coracoacromial ligament is released with a radiofrequency device. The arthroscope is placed in the lateral portal and an acromioplasty is performed using a bone-block technique from posterior to anterior with a motorized bone-cutting shaver. Hemostasis is obtained with a radiofrequency device.”
Important: Keep in mind that many payers will want to see the name of a bone tool being used to support the acromioplasty, Margie Scalley Vaught said in her webinar.
