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Shoulder debridement; Extensive or Limited

Camille Posted Fri 08th of November, 2019 14:32:38 PM
Procedure: Arthroscopic left shoulder rotator cuff repair with debridement of superior labrum and bursectomy. Description: ...A diagnostic arthroscopy showed, in the glenohumeral joint, an unremarkable biceps tendon. There was tearing of the superior labrum which was debrided using a shaver. The humeral head was unremarkable. Glenoid was unremarkable. Anterior and posterior labrum was unremarkable. Camera was then placed in the subacromial space. The bursa was excised using a shaver and ArthroCare wand. The acromion was exposed. I did not see a large acromial spur, so just a bursectomy was performed. The rotator cuff was examined. There was a large full-thickness rotator cuff tear seen. The greater tuberosity was debrided using an ArthroCare wand and a bur. Two lateral portals were made. followed by a superolateral portal for placement of 2 Healix anchors into the greater tuberosity. Sutures were then passed from anterior to posterior in horizontal mattress fashion. Three sutures were passed and tied. There was good approximation of the rotator cuff down to bone. Then, 1 suture from each knot was placed into an Arthrex PushLock and placed in the lateral row anteriorly. One suture from each knot again was taken into a second Arthrex PushLock and placed in the lateral row posteriorly. There was good fixation of rotator cuff down to bone. The portal sites were then closed... MY CODES: 29827/M75.122, 29822/S43.432A. MY QUESTION: I want to use the limited debridement code (29822) vs. the extensive (29823) for the superior labral debridement. I believe the bursectomy and glenoid debridement are included in the rotator cuff repair. Or does the procedure note describe an extensive debridement? Thank you very much!
SuperCoder Answered Mon 11th of November, 2019 06:04:04 AM

Hi Camille,

 

Thanks for your question.

 

Shoulder arthroscopy procedures include limited debridement (e.g., CPT® code 29822). So, you should not report 29822 (limited debridement) separately with rotator cuff repair code. There is a very fine line as to what constitutes true extensive debridement.

 

Generally, the rule of two or more soft tissues applies to coding debridement procedures. If the provider debrides two or more soft tissues (biceps tendon, labrum, bursae, etc.), then you may consider code 29823 (Arthroscopy, shoulder, surgical; debridement, extensive). If the report documents labral and/or bone debridement, for example, you may consider code 29823.

 

NCCI states that you may only report 29823 with rotator cuff repair code if the extensive debridement is performed in a different area of the same shoulder.

 

Now since your doctor has performed debridement of superior labrum and bursa, this may be considered as extensive debridement and may be reported with code for rotator cuff repair.

 

Please feel free to write if you have any question.

 

Thanks

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