CCI 2017 Manual Provides Shoulder Arthroscopy Answers You’ve Been Waiting For

The 2017 CCI manual is here!

You know you’re a coder when news that the new Correct Coding Initiative (CCI) manual out makes you a little giddy. (There’s a good chance I said the same thing about CPT® 2017 when it came out.) I’ve been watching for the CCI manual update ever since the deletion of certain shoulder arthroscopy edits raised questions about how to reconcile the edit change with instructions in the manual.

If your code for shoulder services, be sure to get familiar with these CCI manual updates. (And for the rest of you, be sure to check out the changes to your own chapters. The manual marks updates in red italics.)

Quick recap: The orthopedic edits that got deleted in 2016 bundled extensive debridement (29823) with shoulder arthroscopy procedure codes 29824, 29827, and 29828. This deletion left coders wondering about a conflicting 2016 CCI manual instruction that says not to report debridement with same-joint arthroscopy.

Start With the General Rule

Chapter 4 of the CCI manual is where you’ll find CCI guidelines specific to codes 20000-29999. Section E is about Arthroscopy.

The 2017 manual adds a new subsection 4 that states, “CMS considers the shoulder to be a single anatomic structure.” The CCI guideline goes on to state that when you have a CCI edit involving two shoulder arthroscopy codes, the general rule is that you should not override the edit for services on the ipsilateral, meaning same side, shoulder.

There are three exceptions, though, and, for more on that, subsection 4 points you to subsection 7. I’ll go over the exceptions toward the end of the post. Spoiler alert: The three exceptions relate to the three deleted edits.

Shoulder Joins Knee in Excepted Joints List

Because the 2017 manual adds subsection 4 (described above), the 2016 subsection 4 becomes 2017 subsection 5. The point of mentioning that is: Shoulder coders should be aware of wording in the new subsection 5.

This is the subsection with the trouble-making 2016 rule that essentially says you shouldn’t report debridement when performed in the same joint as an arthroscopy procedure. The 2016 manual lists only the knee as an exception.

The 2017 version brings the subsection in line with the edit deletions by adding the shoulder as an exception: “With the exception of the knee and shoulder, arthroscopic debridement should not be reported separately with a surgical arthroscopy procedure when performed on the same joint at the same patient encounter.”

Exception Twist: Watch for Different Area of the Same Shoulder

You’ll find the most helpful information in new subsection 7. Here’s the breakdown:

  • Shoulder arthroscopy procedures include limited debridement, such as 29822, even if the debridement and procedure are in different areas of the same shoulder
  • Shoulder arthroscopy procedures include extensive debridement, such as 29823, even if the debridement and procedure are in different areas of the same shoulder, BUT there are three exceptions:
    • “CPT® codes 29824 (arthroscopic claviculectomy including distal articular surface), 29827 (arthroscopic rotator cuff repair), and 29828 (biceps tenodesis) may be reported separately with CPT® code 29823 if the extensive debridement is performed in a different area of the same shoulder.”

So there you have it. Be sure you remember both the general rule and when you can apply the exceptions to help keep your shoulder claims compliant.

How About You?

Were you surprised or happy about any of the CCI manual changes? How would you complete the sentence: You know you’re a coder when …?

About 

Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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