Before you code debridement with shoulder arthroscopy, make sure you know what the Medicare Correct Coding Initiative (CCI) manual has to say. You’ll find the highlights here to help you get started.
Same Shoulder? Stick to the Basic CCI Rule
In chapter IV, section E.4, the CCI manual states that “CMS considers the shoulder to be a single anatomic structure,” and so CMS does not allow you to bypass a CCI edit for two shoulder arthroscopy codes when the procedures are on the same shoulder.
But that’s not the end of the story: There are three times when CMS says you can break the rule above and report two arthroscopy codes for the same shoulder. For those exceptions, you need to read section E.7, which you’ll learn more about below.
Dig In to Shoulder Debridement Coding Specifics
Limited debridement: Chapter IV, section E.7, starts by stating that shoulder arthroscopy includes limited debridement (for example, 29822) in the same shoulder. It doesn’t matter if the limited debridement is in a different area of the shoulder than the other procedure. You still should not report the limited debridement separately.
Extensive debridement: The three exceptions for coding arthroscopy along with debridement in the same shoulder relate to extensive debridement (for example, 29823). The same general rule applies that arthroscopy procedures include extensive debridement in the same shoulder even when the procedure and debridement are in different areas of that shoulder.
The exceptions relate to three specific codes. You may report the following codes separately along with 29823 if the surgeon performs the extensive debridement and the other procedure in different areas of the same shoulder:
- 29824 (Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure))
- 29827 (… with rotator cuff repair)
- 29828 (… biceps tenodesis).
Understanding this rule for Medicare coding is important because Medicare does not have CCI edits for 29823 as a column 2 code for 29824, 29827, or 29828 to alert you that there may be an issue with your coding.
Bottom line: Before you report debridement code 29823 along with another arthroscopic shoulder procedure in the same shoulder, make sure you can answer yes to these three questions:
- Was the debridement extensive? (You’ll want to be sure your orthopedic surgeon’s documentation supports that term, which is a tricky topic of its own.)
- Are you reporting the debridement alongside 29824, 29827, or 29828?
- Was the 29824, 29827, or 29828 procedure in a separate area of the shoulder than the 29823 debridement?
What About You?
What tactics do you use to make sure you apply CCI manual instructions to your coding?