CPT Code Description
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 (ie, arch) release, when performed (List separately in addition to code for primary procedure
Codes 29824 and 29826
When reporting 29824, documentation should support that the entire distal end of the clavicle was resected. Neither CPT® nor the Centers for Medicare & Medicaid Services (CMS) state how much bone must be removed to be considered the “entire” distal end. The AMA provided a clinical example when 29824 was first developed — but it was strictly an example, and not all-inclusive of the requirements for reporting. For years, AAOS referenced size in their CodeX and Global Service Data books to be sure surgeons were not reporting 29824 for removing only a spur. Since 2010, however, all “size” references were deleted from AAOS publications.
Many offices have stopped reporting 29824 unless there is a documented reference to size, but this is a mistake. If there is a question as to whether a procedure was done, query the surgeon. Some payers have placed size references in their own internal policies, but that is a payer-contracted issue.
CPT® made 29826 an add-on code several years ago; however, some payers — especially workers’ compensation carriers — have retained 29826 as a full-value code. You may want to double-check this with your contracted payers, also. Per CPT®, +29826 may be reported only with other shoulder arthroscopy codes. Medicare agrees, and allows +29826 to be reported with all other shoulder arthroscopy codes, including 29822 and 29823. Be sure there is clear documentation that bony work was performed on the acromion to support +29826.
Many payers are now requiring a “bony tool” to be referenced in the body of the report for +29826 to be paid. Documentation of converting the acromion from a type 3 to a type 1 can also be beneficial to support this code.
If only a subacromial bursectomy is performed, without any bone resection, report a debridement, not +29826.
Many surgeons continue to perform arthroscopic subacromial decompression alone, or with open shoulder procedures. The AAOS, the Arthroscopy Association of North America, and the AMA advise to report this scenario with an arthroscopic debridement code, 29822 (soft tissue only) or 29823 (bone and soft tissue). If done with an open rotator cuff repair (23410/23412), many payers do not allow separate reimbursement for acromioplasty, regardless of approach with an open or mini-open rotator cuff repair. Check payer policy (and get something in writing) before billing acromioplasty as a debridement code.
Shoulder Arthroscopic Acromioplasty 29826
Code 29826 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) – is now an add-on code meaning it can’t be reported as a stand-alone. But since we started using it Jan 2012 there have been multiple changes. CCI corrected in the bundling edits version 18.1 any previous edits related to 29826. They deleted these pairs, so if you were denied for any claims submitted from Jan 1 to Present, rebill them. If you did not bill the codes because of these edits again from Jan 1 to present send in corrected claims:
“Question: What CPT code(s) may be reported in the event arthroscopic subacromial decompression with partial acromioplasty is performed independent of any other arthroscopic shoulder procedure(s)?
Answer: Code 29822, Arthroscopy, shoulder, surgical; debridement, limited, or code 29823, Arthroscopy, shoulder, surgical; debridement, extensive, may be reported as appropriate when a subacromial decompression is done by itself. For example, if a subacromial decompression is performed alone, which usually involves debridement of soft tissue and bone removal, then code 29822 may be reported. If debridement of bone and soft tissue is performed, this code is correct and accurately describes the work done. If there is extensive work done in the removal of the soft tissue and bone, then one would report 29823.”
In addition to this recommended coding for stand-alone acromioplasty of 29822/29823, there is also the concern of the recommendations from AAOS to use these same codes if a scope acromioplasty is done with an open shoulder procedure such as a mini-open RCR (23410/23412) are payer/carrier opinions. Since 29826 can only be reported with other shoulder scope codes, that means you can’t use the code with any of the open shoulder procedures. However, many payers including Medicare have had long standing policies that state included in open RCR (ie 23410, 23412 and 23420) would be the acromioplasty whether open or scope. If now the coding is coming into the payer/carrier using debridement codes to represent the acromioplasty would this cause issues of as referenced in the March 16, 2000 Federal Register which states “..“Knowingly misrepresenting the nature or level of services provided to a Medicare beneficiary to circumvent the program’s limitation is fraudulent.” Word of advice, double check with your contracted payers/carriers and get it in writing that they agree with the AMA and AAOS policies of how to code acromioplasty.
Arthroscopic shoulder procedures
The traditional coding rule about the shoulder is to consider the joint as one compartment. Due to continuous efforts by orthopaedic societies, a twocompartment (intra- and extra-articular) viewpoint is gaining acceptance. As a result, a few coding rules have changed. Intra-articular structures include the labrum, the long head of the biceps, a Bankart lesion, and the humeral and glenoid articular surfaces. Extra-articular structures include the rotator cuff (RC), the distal clavicle, and the subacromial space.
In 2017, the Centers for Medicare & Medicaid Services (CMS) made a significant change to the extensive debridement code (29823). There are now three situations in which this code can be billed if the extensive debridement portion of the procedure is performed in a separate area of the shoulder joint. This is similar to coding for the knee, which also has distinct anatomic compartments.
The applicable codes are:
• 29824 – arthroscopic distal clavicle resection
• 29827 – arthroscopic RC repair
• 29828 – biceps tenodesis
Remember, that the limited debridement code (29822) is included with the other, more extensive arthroscopic procedure codes. These changes only pertain to the extensive debridement code.
The rules for coding loose body removal in the shoulder (29819) are slightly different. To use that code, the loose body must be larger than 5 mm. When that occurs, coding 29827 (arthroscopic rotator cuff repair) with 29819-59 is permissible.
Additionally, arthroscopic repair of a superior labral anterior posterior (SLAP) lesion (29807) may also be billed with the loose body code (29819-59). Synovectomy codes in both the shoulder and the knee are governed by the same guidance. Code 29820 (synovectomy, partial) is inclusive to more extensive procedures. Code 29821 (synovectomy, complete) should only be used when the underlying diagnosis is pathologic synovium such as is found in rheumatoid arthritis or pigmented villonodular synovitis. Cleaning up the “whole” joint due to reactive synovitis is inclusive of the more extensive codes. The operative report should clearly define what was specifically done during the surgery and provide the medical necessity for the procedure. When an arthroscopic subacromial decompression is performed at the same time that extensive débridement is performed, such as shaving the undersurface of the distal clavicle and débriding chondral surfaces, the primary code is 29823 (extensive débridement) and the secondary code is the acromioplasty (29826). Acromioplasty is an add-on code and can never be the primary code. As an add-on code, it does not require either modifier 51 or 59.
Coverage is subject to the terms, conditions, and limitations of an individual member’s programs or products and the edit criteria listed below. Please compare the claim’s date of adjudication to the range of the edit in question. Prior versions, if any, can be found below.
Description CODE RULE CODE
29825 Incidental 29826
29825-LT Incidental 29826-LT
29825-RT Incidental 29826-RT
29825-59 Separate Reimbursement 29826
Rationale
Anthem Central Region bundles 29825 with 29826, bundles 29825-LT with 29826-LT and bundles 29825-RT with 29826-RT. Based on the National Correct Coding Initiative Edits, code 29825 is listed as a component code to code 29826. Therefore, if 29825 is submitted with 29826—only 29826 reimburses, if 29825-LT is submitted with 29826-LT—only 29826-LT reimburses and if 29825-RT is submitted with 29826-RT—only 29826-RT reimburses.
Anthem Central Region does not bundle 29825-59 with 29826. If a considerable amount of adhesions are present or a great deal of time is required for performing lysis/resection of adhesions, documentation should appear in the operative report and modifier 59 appended to 29825 (29825-59)—then 29825-59 reimburses separately from 29826.
If on appeal, it is documented that considerable amount of time or effort was required to perform lysis or resection of adhesions—then 29825 may separately reimburse when submitted with 29826.
