Procedure code and description
29806 ARTHROSCOPY SHOULDER SURGICAL CAPSULORRHAPHY
29807 ARTHROSCOPY SHOULDER SURGICAL REPAIR SLAP LESION
29819 ARTHROSCOPY SHOULDER SURGICAL REMOVAL LOOSE/FB
29820 ARTHROSCOPY SHOULDER SURG SYNOVECTOMY PARTIAL
29821 ARTHROSCOPY SHOULDER SURG SYNOVECTOMY COMPLETE
29822 ARTHROSCOPY SHOULDER SURG DEBRIDEMENT LIMITED
29823 ARTHROSCOPY SHOULDER SURG DEBRIDEMENT EXTENSIVE average fee payment – $680 – $690
29824 ARTHROSCOPY SHOULDER DISTAL CLAVICULECTOMY
29825 ARTHROSCOPY SHOULDER AHESIOLYSIS W/WO MANIPJ
29826 ARTHROSCOPY SHOULDER W/CORACOACRM LIGMNT RELEASE
29827 ARTHROSCOPY SHOULDER ROTATOR CUFF REPAIR average fee amount – $1000 – $1100
29828 ARTHROSCOPY SHOULDER BICEPS TENODESIS
29826 – Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromialligament (ie, arch) release, when performed (List separately in addition to code for primary procedure) average fee amount – $150 – $200
Billing and Coding Guidelines
The transition to the new CMS ASC payment system, which pays centers at a percentage of HOPD rates, has increased the reimbursement rates of most orthopedic procedures, says Jay Rom, president of Blue Chip Surgical Center Partners. The system, which went into effect Jan. 1, 2008, and was designed to be phased in over a four-year period, continues to benefit orthopedic service lines as the percent of the payment formula determined by the new system is phased into the overall ASC reimbursement rate.
The 2010 Medicare unadjusted base rates for a few of the more popular ASC orthopedic procedures are as follows:
• Arthroscopy, shoulder (CPT 29806) —$1,588.70
Bundled as a component of these arthroscopic procedures:
– 29827 RC repair
– 29828 Biceps tenodesis
– 29807 SLAP repair
If there is a co-surgery, the diagnosis has to match for both OP notes.
When coding for Osteoarthritis we will need the following to be documented within the OP note in order to code and process for billing within a timely manner. I know this is a repeat from last month, but we are starting to receive denials for the use of a more specific diagnosis code.
• Nature of Osteoarthritis (Primary, Secondary, post-traumatic)
• Laterality (Left, Right, Bilateral)
• Anatomical Location (Hip, Knee, CMC, etc.)
What to code when only an Acromioplasty is performed alone(29826) 29826 is defined as an Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (List separately in addition to code for primary procedure).
• This code can only be reported with other scope procedures
• It is not a stand alone code
• If this is the only procedure performed, you should report 29822/29823 per Procedure and AAOS
• What to do if performed with an open procedure… o Procedure 29826 should not be reported with any procedure other than those identified as appropriate parent codes. It is not an add-on code to Procedure 23410 or 23412, and an unlisted code cannot be reported to reflect this work. Instead, you should report 29822 or 29823 as appropriate.
Arthroscopic labrum repairs
Report CPT 29806 for surgical capsular repairs when they’re performed arthroscopically. Rather than reporting CPT code 29806 for arthroscopic thermal capsulorrhaphy, use the unlisted code 29999 versus S2300 for arthroscopic thermal capsulorrhaphy, pending carrier guidelines.
Note that many commercial carriers don’t recognize S codes. Here’s an opportunity going forward to incorporate S codes and unlisted codes into your facility’s new and revised commercial insurance contracts.
In addition, your facility will want to review implants and Category III codes in order to separately define or carve out these supplies or procedures.
Simply because a labrum is torn and repaired, it doesn’t automatically warrant reporting 29807 if the torn labrum isn’t a SLAP (superior labrum from anterior to posterior) tear. CPT 29807 is specific for a SLAP repair; don’t use it for labral tears that aren’t SLAP tears.
The surgeon will determine whether there is a true SLAP tear and also the “type” of SLAP.
Report both 29807 and 29806 per AAOS if the surgeon performs SLAP Type II or Type IV in addition to capsulorrhaphy for a different indication. To simplify, there should be two separate and distinct indications to report the capsular repair and the SLAP tear repair. Verify with commercial carriers as to reporting guidelines for CPT 29807 and 29806 during the same session.
Medicare edits bundle CPT code 29807 into CPT 29806 at this time, but allows for a modifier if the surgeon performs SLAP separately and distinctly from the capsulorrhaphy. Use caution when considering the application of a modifier. Remember the terms “separate” and “distinct.” Simply because you can use a modifier doesn’t imply automatic application of a modifier with every scenario.
A coder shouldn’t confuse the surgeon’s repair of the labrum by attaching it to the capsule as a separately identifiable capsulorrhaphy. The separate reporting of the capsulorrhaphy is indicated when there is a capsular defect unrelated to the labrum tear that in itself also warrants a repair.
Arthroscopic SLAP debridement is reported from the arthroscopic shoulder debridement codes pending other debridements performed during the operative session. These debridement codes may be considered inclusive into other surgical procedures performed during the same operative session.
Arthroscopic Labrum Repairs Codes
CPT Code Procedure
29806 Arthroscopic surgical shoulder; capsulorrhaphy
29807 Arthroscopic surgical shoulder; repair of SLAP Lesion
* Procedure Code 29827 – Arthroscopy, shoulder, surgical; with rotator cuff repair
* Procedure Code 29820 – Arthroscopy, shoulder, surgical; synovectomy, partial
Procedure code 29820 should not be reported and modifier 59 should not be used if both procedures are performed on the same shoulder during the same operative session because the shoulder joint is a single anatomic structure. If the procedures are performed on different shoulders, modifiers RT and LT should be used, not modifier 59.
Modifier 59 is used appropriately for different anatomic sites during the same encounter only when procedures which are not ordinarily performed or encountered on the same day are performed on different organs, or different anatomic regions, or in limited situations on different, non-contiguous lesions in different anatomic regions of the same organ
Medicare professional fees for orthopedic procedures are, on average, more than 40 percent less than the average commercial payments. Medicare pays physicians significantly less than commercial payors for performing orthopedic procedures, but the differences between the two payors vary by procedure. For example, the Medicare allowable for a shoulder arthroscopy with lysis and resection of adhesions (CPT 29825) is $593 while the average commercial payment for the procedure in $1,350 — a payment of more than double the Medicare allowable. The Medicare allowable for shoulder arthroscopy; capsulorrhaphy (CPT 29806) is $1,071, and the average commercial payment is $1,285 — only 16 percent more than the Medicare allowable.
Rotator cuff repair and reconstruction
•Effective Apr. 1, 2012 the edit bundling Procedure code 29822 into 29826 will be removed
•After Apr. 1, 2012, the provider may resubmit the claim if the local A/B MAC permits, or appeal previously denied claims involving the NCCI edit code pair (Opportunity to increase revenue on previously denied claims when the ASC remains updated to changes)
Column 1 Code / Column 2 Code – 29827/29820
>CPT Code 29827 – Arthroscopy, shoulder, surgical; with rotator cuff repair
>CPT Code 29820 – Arthroscopy, shoulder, surgical; synovectomy, partial
CPT code 29820 should not be reported and modifier 59 should not be used if both procedures are performed on the same shoulder during the same operative session because the shoulder joint is a single anatomic structure. If the procedures are performed on different shoulders, modifiers RT and LT should be used, not modifier 59.
Modifier 59 is used appropriately for different anatomic sites during the same encounter only when procedures which are not ordinarily performed or encountered on the same day are performed on different organs, or different anatomic regions, or in limited situations on different, non-contiguous lesions in different anatomic regions of the same organ.
ARTHROSCOPY, SURGICAL SHOULDER – Authorization request.
The following CPT code(s) require prior authorization: Code Description
29806 Arthroscopy, shoulder, surgical; capsulorrhaphy
29807 Arthroscopy, shoulder, surgical; repair of SLAP lesion
29819 Arthroscopy, shoulder, surgical; with removal of loose body or foreign body
29822 Arthroscopy, shoulder, surgical; debridement, limited
29823 Arthroscopy, shoulder, surgical; debridement, extensive
29824 Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure)
29825 Arthroscopy, shoulder, surgical; with lysis and resection of adhesions, with or without manipulation
29826 Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (i.e., arch) release, when performed (list separately in addition to code for primary procedure)
29827 Arthroscopy, shoulder, surgical; with rotator cuff repair
29828 Arthroscopy, shoulder, surgical; biceps tenodesis