Shoulder Surgery : Coding and Billing

Diagnostic specificity: In the current value-based reimbursement system, specificity of the diagnosis is vital. In ICD-10, diagnostic codes require anatomical specificity and laterality as to the area on the body such as: left, right, bilateral. In addition, the 7th digit should be added to the ICD-10 code, as follows:

• A – Initial encounter,
• D – subsequent encounter, and
• S – sequel.

29806   ARTHROSCOPY SHOULDER SURGICAL CAPSULORRHAPHY
29807   ARTHROSCOPY SHOULDER SURGICAL REPAIR SLAP LESION
29819   ARTHROSCOPY SHOULDER SURGICAL REMOVAL LOOSE/FOREIGN BODY 
29820   ARTHROSCOPY SHOULDER SURGICAL SYNOVECTOMY PARTIAL
29821   ARTHROSCOPY SHOULDER SURGICAL SYNOVECTOMY COMPLETE   29822 ARTHROSCOPY SHOULDER SURGICAL DEBRIDEMENT LIMITED
29823   ARTHROSCOPY SHOULDER SURGICAL DEBRIDEMENT EXTENSIVE
29824   ARTHROSCOPY SHOULDER DISTAL CLAVICULECTOMY
29825   ARTHROSCOPY SHOULDER AHESIOLYSIS WITH OR WITHOUT MANIPULATION
29826   ARTHROSCOPY SHOULDER WITH CORACOACRMLIGMNT RELEASE
29827   ARTHROSCOPY SHOULDER ROTATOR CUFF REPAIR a
29828   ARTHROSCOPY SHOULDER BICEPS TENODESIS

Remembering Point

 Diagnostic Arthroscopy code 29805 (Arthroscopy, shoulder, diagnostic with or without synovial biopsy) is reported only for diagnosis. If the diagnostic arthroscopy is followed by an open procedure, the diagnostic procedure cannot be used and only the code for the open procedure can be reported.

To qualify for reimbursement of distal claviculectomy, documentation should support removal of 8-10 mm from the distal clavicle/joint.

 A lot of the codes that were once unbundled and would normally be allowed — such as the 59 modifier, XP, XE, XS and XU modifiers.

For example, when coding a right arthroscopic rotator cuff repair with a distal caviculectomy, acromioplasty and debridement of the labrum, coders may be used to reporting:

•    29827 RT: Arthroscopy, shoulder, surgical; with rotator cuff repair RT side
•    29824 RT: Arthroscopy, shoulder, surgical distal claviculectomy including distal articular space surface (Mumford procedure),
•    +29826 RT: Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty with coracoacrmial ligament (arch) release, when performed
•    And 29822 RT- 59: Arthroscopy shoulder surgical; debridement limited distinct procedural service

 For Medicare cases, we can’t bill the 29826 Arthroscopic Subacromial Decompression procedure because it is an “add-on code” that is considered a “packaged procedure” by Medicare that is not separately payable

 If a Synovectomy is done for visualization or approach and not primarily done as a separate procedure with its own reason, it should not be billed, even if it is in a different area from another procedure.

 If a shoulder manipulation is done in the same case with an arthroscopic shoulder procedure, it is not separately billable.

 Billing for cases that start as “mini-open” and convert to open procedure. If a procedure starts out as a being performed through the arthroscope but then the surgeon makes an incision a “mini-open” procedure, and completes the procedure as an open procedure, only the code for the open procedure should be billed.

 

Read Also:

• Coding Guideline of SLAP repair
• Coding Guideline of rotator cuff repair
• Coding Guideline of Bankart procedure
• Coding Guideline of Mumford procedure