Get Up to Speed On The New Status of 29826

Wed, Apr 11, 2012 --

Coding Updates

The way you’ll report arthroscopic acromioplasties has changed this year, so not applying 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]), which is no longer a standalone code, properly can cost you your reimbursement.

This article tells you how to report + 29826 in addition to codes for other primary procedures in 2012.

Document Additional Primary Procedures

The status of the CPT® code +29826 changed from a standalone to an add-on code in 2012. This means that you can now report this only when your surgeon does another scope procedure as the primary procedure.

Coders have been reporting code 29999 (Unlisted procedure, arthroscopy) when only an arthroscopic subacromial decompression of the shoulder was performed.

“Originally AAOS advised use of the unlisted procedure code 29999 when performing 29826 alone. Recent clarification from AMA/CPT is to use CPT® codes 29822 or 29823, depending upon the extent of debridement supported by the operative report,” says Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner, Precision Auditing and Coding, senior orthopedic coder & auditor, The Coding Network, Washington.

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“When performing an arthroscopic acromioplasty alone, submission using the unlisted arthroscopy code of 29999 has been widely practiced,” says Ruby O’Brochta-Woodward, BSN, CPC, CCS-P, COSC, ACS-OR, compliance and research specialist, Twin Cities Orthopedics, P.A. “The AMA has long stood by the theory that if an appropriate code does not exist, the procedure should be submitted using the appropriate unlisted CPT® code.”

What the change means: You can now turn to 29822 (Arthroscopy, shoulder, surgical; debridement, limited) or 29823 (Arthroscopy, shoulder, surgical; debridement, extensive). “Both the AMA and AAOS have issued statements that the appropriate debridement code (29822 or 29823) should be reported when arthroscopic subacromial decompression is performed as a standalone procedure,” says Heidi Stout, BA, CPC, COSC, PCS, CCS-P, Coder on Call, Inc., Milltown, New Jersey and orthopedic coding division director, The Coding Network, LLC, Beverly Hills, CA.

The scope procedures that you may commonly encounter for primary procedures are the arthroscopic claviculectomy, arthroscopic rotator cuff repair, arthroscopic debridement (debridement unrelated to the work performed for the decompression), or arthroscopic biceps tenodesis. “The add-on code +29826 is allowed with CPT® codes 29806 — 29825, 29827 and 29828,” says Stumpf. These are listed below:

  • 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)
  • 29820 (Arthroscopy, shoulder, surgical; synovectomy, partial)
  • 29821(Arthroscopy, shoulder, surgical; synovectomy, complete)
  • 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)
  • 29827 (Arthroscopy, shoulder, surgical; with rotator cuff repair)
  • 29828 (Arthroscopy, shoulder, surgical; biceps tenodesis)

“There is a current CCI edit disallowing use of 29826 with 29822. There has been verification from CMS that this edit is to be lifted in the CCI update for April 2012. The 29822/29826 CCI edit will be lifted retroactive to January 1, 2012. If you have been receiving denials, please hold these claims for refilling under the new edits being released in April 2012,” says Stumpf.

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Additional option: When your surgeon performs an arthroscopic subacromial decompression as the only procedure, you may turn to codes 29822 or 29823, depending upon whether your surgeon does a limited or extensive debridement.

However, you will need to ensure that your surgeon is aware of the significance of these codes and documents all the procedures done in detail. Do not forget to confirm with your payer the protocols or definitions that the payer is using for the arthroscopic subacromial decompression when it is the only procedure performed. “There is uncertainty for 29822 when attempted to be billed with 29826. Private payers may deny it though Medicare is likely to allow it,” says Bill Mallon, MD, medical director, Triangle Orthopedic Associates, Durham, N.C.

“According to the AMA, one should report code 29822 or 29823 when arthroscopic subacromial decompression is performed either as a solo procedure or in conjunction with other procedures that are not parent codes,” says Heidi Stout, BA, CPC, COSC, PCS, CCS-P, Coder on Call, Inc., Milltown, New Jersey and orthopedic coding division director, The Coding Network, LLC, Beverly Hills, CA.

Follow These Rules When Reporting Open Procedures

You shouldn’t report code +29826 as add-on code with codes for open rotator cuff repair, 23410 (Repair of ruptured musculotendinous cuff [eg, rotator cuff] open; acute) or 23412 (Repair of ruptured musculotendinous cuff [eg, rotator cuff] open; chronic).

“In this case, you turn to 29822 or 29823 for arthroscopic subacromial decompression,” says Stout. You will need to check with your payer and confirm if you can report these codes with modifier 22 (Increased Procedural Services……). “There is no cross over for use of the new add-on code 29826 with open codes,” says Stumpf. “Per AAOS Now CPT Code Update 2012 — Part 1, the recommendations are to use the 22 modifier in addition to CPT® codes 23410 and 23412 or to report 29822 or 29823 (limited or extensive debridement) based on the documentation. This would be a care center, provider and/or perhaps a carrier driven choice,” she advises.

Your surgeon, as a common practice, may be doing an arthroscopic acromioplasty with open procedures. “Many of our providers perform an arthroscopic decompression with an open distal clavicle excision,” says O’Brochta-Woodward.

The billing together for procedures like arthroscopic decompression and open distal clavicle excision in CCI has been an area of concern to coders. “These two procedures have never been considered bundled in CCI. With the current coding nomenclature, an arthroscopic acromioplasty can no longer be billed with an open distal clavicle excision since 29826 must be billed with a primary arthroscopic procedure,” says O’Brochta-Woodward. “There has been much concern in the orthopedic community, as this code relates to the performance of an arthroscopic acromioplasty in combination with an open rotator cuff repair (23410 or 23412). This code combination has always been bundled in CCI allowing for a modifier only if the procedure was performed on the opposite shoulder. Several years ago AAOS published an article promoting separate ‘areas’ in the shoulder (subacromial, glenohumeral and acromioclavicular) thus promoting the ability to submit procedures considered bundled in CCI with the use of the 59 (Distinct Procedural Service…) modifier. This concept however was never adopted by CMS. CMS has never recognized the separate areas of the shoulder. Thus, when submitting claims to Medicare or to other health plans who follow Medicare’s rules, appending the 59 modifier was being done in error.”

About

Barnali Gogoi is a medical coding and billing writer with over 7 years of experience in the industry. She holds a Masters Degree in English Literature from Gauhati University and a diploma in advertising and marketing from YMCA.

3 Comments For This Post

  1. laurie Thelin Says:

    What is the clarification from the AMA that the author is referring to when she says to use 29822 or 29823 instead of 29999? I have found nothing in CPT Assistant or the AMA website. Can the author site her source?

  2. barnalig Says:

    Hi Laurie,

    Status of 29826 has changed; this is now an add-on code. The “2012 CPT Changes: An Insider’s View” states – “Code 29826 is billed more than 95% of the time with other arthroscopic repair of the shoulder codes. Therefore, it was decided that instead of relying on multiple procedure reduction rules, it would be better to convert 29826 to an add-on code.”

    As of January 2012, AMA states, “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.”

    Similar opinion has been voiced by coding experts too whose statements can be found in the same article.

    We hope this will help your understanding.

    Thanks

  3. barnalig Says:

    Hi Laurie,

    You can even check out the link below…it should answer your question:

    http://www.aaos.org/news/aaosnow/jan12/managing4.asp

    Please let me know if I can help any further.

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