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The following article is written by Cristina Bentin, CCS-P, CPC-H, CMA, president of Coding Compliance Management.
The revision of CPT 29826 from a standalone code to an add-on code — +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)) — has been a source of contention to say the least.
The arthroscopic subacromial decompression procedure became an add-on procedure in 2012. In most cases, an arthroscopic subacromial decompression is performed with other separately identifiable procedures. However, if the arthroscopic decompression is the only procedure performed/documented, add-on code +29826 cannot be reported as a stand-alone code.
CPT +29826 may only be reported in addition to the parent code/primary procedure. Examples of primary procedures include but are not limited to arthroscopic rotator cuff repairs, arthroscopic debridements (the debridement would be performed on an area separate/distinct and unrelated to the work performed for the decompression), or an arthroscopic claviculectomy (i.e., CPT 29806–29825, 29827, and 29828).
Questions have arisen as to the reporting of +29826 with open rotator cuff repair code 23410 or 23412 when performed during the same operative session. According to the American Academy of Orthopedic Surgeons, "CPT code +29826 should not be reported with any procedure other than those identified as appropriate parent codes. Furthermore, +29826 is not an add-on code to CPT code 23410 or 23412, and an unlisted code may not be reported to reflect this work." AAOS and the American Medical Association recommend reporting CPT 29822 or CPT 29823 (limited or extensive débridement) as appropriate rather than the add-on code.
AAOS and AMA directives have led to more questions. For example, what should be reported when an arthroscopic subacromial decompression is the only procedure performed? As of January 2012, according to AMA, "CPT code 29822, Arthroscopy, shoulder, surgical; debridement, limited, or CPT code 29823, Arthroscopy, shoulder, surgical; debridement, extensive, would be reported as appropriate, when an arthroscopic subacromial decompression is the only procedure performed."
Still in question is the specific documentation required to determine the debridement code selection if different from traditional debridement determination. If CPT 29822 or CPT 29823 should be reported, what would define the selection?
Until further clarification is provided, what should your facility do? Follow these three steps:
- Remain diligent in monitoring guideline changes from AMA, AAOS, and CMS.
- Contact payers and verify definitions/protocol for reporting the arthroscopic subacromial decompression when it is the only procedure performed.
- Ensure your physicians are aware of the directives and they provide detailed documentation of all procedures performed.
To contact Cristina Bentin (cristina@ccmpro.com) and learn more about Coding Compliance Management, visit www.ccmpro.com.
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
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