Knowledge Base Article

Q:

Can debridement be reported separately in addition to shoulder arthroscopy procedures?

A:

The answer is it depends. Although the shoulder has three “areas” or “regions”: the glenohumeral joint, the acromioclavicular joint and the subacromial bursal space, CMS generally considers the shoulder to be a single anatomic structure. Arthroscopic treatment of a shoulder injury in adjoining areas of the same (ipsilateral) shoulder constitutes treatment of a single anatomic site. National Correct Coding Initiative (NCCI) procedure-to-procedure edits should not be bypassed with the addition of a modifier for arthroscopic shoulder procedures unless performed on the opposite (contralateral) shoulder.Limited debridement (e.g. CPT code 29822) and usually extensive debridement (e.g. CPT code 29823) are included in shoulder arthroscopy procedures even if the limited debridement is performed in a different area of the same shoulder than the other procedure. According to the American Association of Orthopaedic Surgeons Coding, Coverage and Reimbursement Committee, “Code 29822 covers limited debridement of soft or hard tissue and should be used for limited labral debridement, cuff debridement or the removal of degenerative cartilage and osteophytes. Code 29823 should be used only for extensive debridement of soft or hard tissue. It includes a chondroplasty of the humeral head or glenoid and associated osteophytes or multiple soft tissue structures that are debrided such as labrum, subscapularis and supraspinatus.” (see April 2006 AAOS Bulletin)

However, CMS does make three exceptions related to separate reporting of extensive debridement in Section E, Chapter 4 of the NCCI policy manual. If extensive debridement (CPT 29823) is performed in a different area of the same shoulder with one of the following arthroscopic shoulder procedures, it may be reported separately:

• CPT 29824 – Arthroscopic claviculectomy including distal articular surface
• CPT 29827 – Arthroscopic rotator cuff repair
• CPT 29828 – Biceps tenodesis

Remember, the separate reporting of extensive debridement only applies to the three CPT codes listed above. Extensive debridement is included in other shoulder arthroscopy procedures, for example CPT codes 29806, 29807, and 29821. Section I. of Chapter 4 of the NCCI policy manual states, “With limited exceptions open or arthroscopic procedures performed on a joint include debridement (open or arthroscopic) if performed. A debridement code may be reported with a joint procedure code only if the debridement is performed on a different joint or at a site unrelated to the joint. See Section E (Arthroscopy) for discussion of exceptions.”

Reference: National Correct Coding Initiative (NCCI) Policy Manual, 2017, Chapter 4.