march 2017

Shoulder Debridement

CMS still considers the shoulder to be a single anatomical structure so when you have two arthroscopic codes that bundle and both of those procedures are performed on the same shoulder you would not report the bundled code. For example – the physician performs an arthroscopic rotator cuff repair (29827) and a limited debridement of the labrum (29822); because both procedures are performed on the same shoulder you can only report the rotator cuff repair 29827. The exception to this rule is when the rotator cuff repair is performed on one shoulder (RT) and the limited debridement is performed on the opposite shoulder (LT).

The biggest changes came with CPT code 29823. There are 3 exceptions where it would be appropriate to report the extensive debridement code 29823 when it is performed in a different area of the same shoulder and the key component here is that it must be a “different area” of the shoulder. If the rotator cuff and labrum were both debrided and then subsequently repaired the debridement is included in the repair code and not separately reported.

CPT code 29823 extensive debridement may be reported with the following CPT codes when the guidelines listed above have been followed:

  • 29824 – arthroscopic distal claviculectomy
  • 29827 – arthroscopic rotator cuff repair
  • 29828 – arthroscopic biceps tenodesis

These code pairs do not bundle so it is not necessary to append modifier -59 to code 29823.


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