Coding the Arthroscopic shoulder debridement procedure was slightly confusing in the past, and it got resolved with the revision of codes introduced by AMA in 2021.
The code descriptors for CPT code 29822 and 29823 have been revised based on the number of discrete structures in shoulder got debrided along with the examples of different shoulder site structures but not limited to humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, and foreign body(ies).
Clear documentation of debridement site by the provider in the operative report will help the coders to assign the appropriate CPT code.
Revised code description for CPT code 29822 and 29823 are:
29822 Arthroscopy, shoulder, surgical; debridement, limited, 1 or 2 discrete structures (e.g., humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body[ies]
29823 Arthroscopy, shoulder, surgical; debridement, extensive, 3 or more discrete structures (e.g., humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body[ies]
NCCI Rule on reporting Arthroscopic Shoulder Debridement Codes:
Here are the few important CMS guidelines that we need to remember while coding the arthroscopic shoulder debridement codes along with the other shoulder arthroscopy procedures.
- With 3 exceptions (which are described in Chapter IV, Section E (Arthroscopy), Subsection 7), an NCCI PTP edit code pair consisting of 2 codes describing 2 shoulder arthroscopy procedures shall not be bypassed with an NCCI PTP-associated modifier, while the two procedures are performed on the ipsilateral shoulder. This type of edit may be bypassed with an NCCI PTP associated modifier only if the two procedures are performed on contralateral shoulders.
- 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 apart from the other procedure.
- With 3 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 apart from the other procedure. CPT codes 29824 (Arthroscopic claviculectomy including distal articular surface), 29827 (Arthroscopic rotator cuff repair), and 29828 (Biceps tenodesis) may be reported separately with CPT code 29823 if the extensive debridement is performed in a different area of the same shoulder.
Clinical Example:
29822
A 65-year-old male presents with right shoulder pain. His conservative management got failed, so he decided to go with surgical options. MRI shoulder showed a tear of the supraspinatus tendon. A diagnosis of symptomatic supraspinatus tear is made. An arthroscopic debridement of the right supraspinatus tendon is performed.
29823
A 55-year-old male presents with chronic left shoulder pain. His conservative management got failed, so he decided to go with surgical options. MRI shoulder showed chondral degeneration of the humeral head and the glenoid and a partial bursal surface tear of the supraspinatus tendon in the left shoulder. An articular cartilage degeneration and a partial rotator cuff tear in the left shoulder was diagnosed. An arthroscopic debridement of the humeral head, glenoid and supraspinatus tendon is performed on the left shoulder.
References:
- CPT Assistant, December 2020
- NCCI Policy Manual for Medicare 2021: Chapter 4