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SLAP Lesions: Coding Guideline of Arthroscopic SLAP Repair

A very common diagnosis for shoulder injuries is a superior labral tear, or SLAP tear. SLAP stands for Superior Labral tear Anterior to Posterior.  There many different variations of SLAP tears, which have different levels of severity and treatment strategies.

Classification of SLAP Lesions

Type 2 is the commonest type of SLAP tear. The superior labrum is completely torn off the glenoid, due to an injury (often a shoulder dislocation). This type leaves a gap between the articular cartilage and the labral attachment to the bone.

Type 2 SLAP tears can be further subdivided into (a) anterior (b) posterior, and (c) combined anterior-posterior lesions. Treatment is reattachment of the labrum (SLAP repair). This is done arthroscopically (keyhole) using suture anchors. 

CPT code 29806 – Arthroscopy, shoulder, surgical; capsulorrhaphy.

CPT code 29807 – Arthroscopy, surgical; repair of a superior labrum anterior/posterior (SLAP) lesion

 CPT 29806 for surgical capsular repairs when performed arthroscopically. The surgeon’s repair of the labrum by attaching it to the capsule as a separately identifiable capsulorrhaphy.

 Type I SLAP lesion is always coded as 29822 (Arthroscopic debridement, limited).

CPT codes 29806 with 29807 is used when SLAP lesion repair is Type 2 or Type 4.” This indicates that, for the other five types of SLAP lesions, it may not be appropriate to report 29807 along with 29806.

 Type III SLAP lesions are bucket-handle tears and can be either debrided or repaired; use 29822 or 29807, whichever is appropriate. Adding code 29806 (Arthroscopy, shoulder, surgical, capsulorrhaphy) for repair of a SLAP lesion is never appropriate unless there is a capsular defect in an area different than the SLAP. This is one of the most common coding errors.

 The purpose of thermal capsulorrhaphy (TC), also called electrothermal therapy,
electrothermal arthroscopy, or thermal shrinkage, is to treat joint instability or
looseness of the shoulder ligaments primarily, but has also been used on other
joints. The procedure utilizes a radiofrequency probe or laser to deliver
non ablative heat, which is intended to cause shrinkage of the collagen fibers
comprising the ligaments or joint capsule, thereby tightening the capsule and
stabilizing the join. Use the unlisted code 29999 versus S2300 for arthroscopic thermal capsulorrhaphy.

S2300 Arthroscopy, shoulder, surgical; with thermally-induced capsulorrhaphy
23929 Unlisted procedure, shoulder
29999 Unlisted procedure, arthroscopy (Explanatory notes must accompany claims billed with unlisted codes.)

 Arthroscopic SLAP debridement is included into other surgical procedures performed during the same operative session.

 According to Medicare edits bundle CPT code 29807 into CPT 29806  but can use modifier if the surgeon performs SLAP separately and distinctly from the capsulorrhaphy.

 CPT 29807 is specific for a SLAP repair; don’t use it for labral tears that aren’t SLAP tears.

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