march 2014

Arthroscopic Shoulder Debridement

Medicare CCI Edit Guidelines now have two instructions that should not be overlooked by coders. The first guideline being the fact that a shoulder joint is considered ONE anatomical area, so whenever two procedures are performed on the same shoulder and one procedure bundles into another the bundled procedure should not be reported.  For example, the patient has a rotator cuff repair and labral debridement.  Many coders would report this service as 29827 and 29822-59 justifying the use of modifier -59 by stating that “this was a different area.”  Not so according to CCI edit guidelines which consider the entire shoulder to be one anatomical area.

“CMS considers the shoulder joint to be a single anatomic structure. An NCCI procedure to procedure edit code pair consisting of two codes describing two shoulder joint procedures should never be bypassed with an NCCI-associated modifier when performed on the ipsilateral shoulder joint. This type of edit may be bypassed only if the two procedures are performed on contralateral joints.”

NEW IN 2014.  This next guideline came as a surprise.  It states that arthroscopic debridement should not be reported with another surgical procedure on the same joint.  We always knew that a debridement procedure would not be reported on the same structure being repaired, such as debridement of the rotator cuff followed by rotator cuff repair, but the instructions for this guideline indicate that you should not be reporting debridement “on the same joint” as the surgical procedure.

“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.” 

 







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