CPT Code CPT Description
29827 Arthroscopy, shoulder, surgical; with rotator cuff repair
The provider examines the tissue inside the shoulder joint with an arthroscope. She inserts additional instruments to repair a torn rotator cuff, the grouping of muscles and tendons that surround and support the shoulder joint. Rotator cuff tears frequently result from sports injuries and repetitive overhead motion of the arm, causing pain and limitation of movement.
29828 The provider examines the tissue inside the shoulder joint with an arthroscope. She inserts additional instruments to repair an unstable biceps tendon, the fibrous band that connects the biceps muscle in the forearm to its bony attachment at the shoulder join. Biceps tenodesis corrects instability of the biceps tendon due to biceps tendonitis, inflammation of the tendon, which tends to accompany other shoulder problems, such as chronic instability, arthritis, and impingement syndrome.
These changes are valid only for the extensive debridement code. It should be noted that the limited debridement code (29822) includes other, more extensive
arthroscopic procedure codes.
** 29819 Arthroscopy, shoulder, surgical; with removal of loose body or foreign body: The AAOS points out that to use code 29819, the loose body in the shoulder should be larger than 5 mm. In this situation, coding 29827 (arthroscopic rotator cuff repair) with 29819-59 is allowed. Also, code 29807 arthroscopic repair of a superior labral anterior posterior (SLAP) lesion may also be billed with the loose body code (29819-59).
** Coding for SLAP (Superior Labrum Anterior and Posterior) Lesions
** A clear understanding of the anatomy of the lesion is essential for coding SLAP lesions correctly. A SLAP injury involves the top part of the labrum, where the biceps tendon attaches to the labrum. A SLAP tear occurs both in front (anterior) and back (posterior) of this attachment point. This injury can also involve the biceps tendon. The four types of SLAP tears are:
** Type I-labral fraying with firmly attached labrum and biceps origin
** Type II-labrum and biceps origin are detached from the labrum
** Type III-bucket-handle labral tear with firmly attached labrum and biceps origin
** Type IV-bucket-handle tear of superior labrum with extension into the biceps tendon with biceps displacement
Type I and Type III SLAP lesions with firmly attached labrum and biceps origin are coded as 29822 (arthroscopic debridement, limited). Types II and IV involve disruption of the labrum attachment and should be reported using code 29807 to indicate repair of the lesions. The operative report should have a detailed
description of the anchor or suture repair. Code 29823 should only be used if more extensive debridement is performed during the operation.
Coding for shoulder procedures has changed significantly since 2004. If you haven’t stayed current, chances are you are under- or over-coding. To make sure you recoup proper reimbursement, let’s address CPT® codes 29821, 29822, 29823, 29824, 29826, 29827, 29828, 29806, and 29807, as well as arthroscopic superior capsular reconstruction (ASCR)
The December 2016 CPT® Assistant further clarifies that an extensive debridement “additionally includes removal of osteochondral and/or chondral loose bodies, biceps tendon and rotator cuff debridement, and abrasion arthroplasty.” Do not separately report the debridement if the surgeon also repairs the debrided structures. Also, most payers consider the labrum to be one structure, and do not divide it into upper or lower portions for debridement.
As of July 1, 2016, (and as further clarified in the updated National Correct Coding Initiative (NCCI) guidelines effective Jan. 1, 2017), 29823 may be reported separately with 29827 Arthroscopy, shoulder, surgical; with rotator cuff repair, 29828 Arthroscopy, shoulder, surgical; biceps tenodesis, and 29824 Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure). With few exceptions, NCCI edits bundle arthroscopic debridement into all arthroscopic surgical codes for the joint being worked on. For example, when performing a superior labral tear from anterior to posterior (SLAP) repair (29807 Arthroscopy, shoulder, surgical; repair of SLAP lesion) and a debridement of a rotator cuff tear and biceps tear (29823), you cannot separately report 29823, per NCCI guidelines, because the debridement is considered inclusive (unless it’s for the opposite shoulder; see NCCI guidelines, chapter 4).
Bonus tip: For arthroscopic rotator cuff repair with debridement of the biceps tendon and debridement of the labrum, along with a bony acromioplasty, you may report 29827, +29826 Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (List separately in addition to code for primary procedure), and 29823 because the bundling edit is removed from 29827 and 29823.
Codes 29827 and 29828
Only one rotator cuff repair code is allowed, per shoulder. Whether one or all four components that make up the rotator cuff (supraspinatus, infraspinatus, teres minor, and subscapularis (SITS)) are repaired in a single shoulder, report a single unit of 29827. If the surgeon begins a rotator cuff repair arthroscopically, but converts to a mini-open approach to finish, report only the appropriate “open” CPT® code (23410 Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute or 23412 Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; chronic). You may report 23410/23412 with modifier 22 Unusual procedural service appended to account for the arthroscopic work done prior to the open portion. Do not report both the open and arthroscopic codes because the work was in the same anatomic location and same session, which does not support the definition of modifier 59 Distinct procedural service.
ASCR is a newer arthroscopic procedure for an irreparable rotator cuff. This procedure involves placement of a fascia lata or similar graft that is attached to the top of the glenoid and greater tuberosity of the humerus. This is not a side to side or reattachment of the cuff tissue; it involves placement of graft material, which makes it a reconstruction, not a repair. There is no CPT® code to describe this procedure. Per the AMA Coding Committee, CPT® guidelines, and April 2017 CPT® Assistant, ASCR may be reported as an unlisted procedure (29999 Unlisted procedure, arthroscopy). It’s inappropriate to report ASCR using 29827 (either with or without modifier 22). Code 29828 Arthroscopy, shoulder, surgical; biceps tenodesis represents an arthroscopic biceps tenodesis. A mini-open biceps tenodesis should be coded as open with 23430 Tenodesis of long tendon of biceps. Prior to biceps tenodesis, the surgeon often debrides and cuts the biceps (tenotomy). This is inclusive to the tenodesis, so do not report it separately.
Biceps tenodesis, or transferring the attachment of the biceps to the humerus (23430/29828), may be reported separately, according to CPT® Assistant (July 2016), and is not part of a normal rotator cuff repair.
Codes 29806 and 29807
When 29806 Arthroscopy, shoulder, surgical; capsulorrhaphy and 29807 were developed, William Beach, MD, of the AAOS Coding Committee stated the goal was to divide the labrum in half (29807 upper half, 29806 lower half). Ideally, the surgeon documents where on the labrum the work was performed; referencing “clock” positions is the best form of documentation. For example, “The patient had a labrum tear from 11 o’clock to 2 o’clock, with tacks/ anchors/etc. placed at 11, 1, and 2 o’clock.” This documentation indicates the surgeon worked on the upper half of the labrum code, and supports 29807.
NCCI now bundles codes 29806 and 29807, and only allows one per shoulder, per session. Per the AAOS Bulletin, for top and bottom repairs of the labrum at the same session, append modifier 22 to the code to acknowledge the additional work performed. Check with private payers, as well as workers’ compensation carriers, to see if they allow either 29806 or 29807 on the same shoulder. NCCI also bundles 29806 and 29827, and will only allow one of the codes per shoulder, per session.
To indicate procedures on different shoulders, you may use modifiers LT Left side and RT Right side. You can read about this issue under NCCI guidelines, chapter 4.
Background: The rotator cuff is a frequent location of shoulder pain which can result in weakness and shoulder instability. Arthroscopic rotator cuff repair is a procedure to repair tears of the rotator cuff.
Description of Special Study: The CERT review contractor conducted a special study of claims with lines for arthroscopic rotator cuff repair procedures billed with Healthcare Common Procedure Coding System (HCPCS) code 29827 (arthroscopy, shoulder, surgical; with rotator cuff repair) submitted from January through March 2016.
Finding: Insufficient Documentation Causes Most Improper Payments
Most improper payments for HCPCS code 29827 in this special study were due to insufficient documentation errors. Insufficient documentation means something was missing from the medical records. For example, claims with insufficient documentation lacked one or more of:
• Supporting documentation for the medical necessity of the procedure
• Procedure note
• Physician’s signature, or signature attestation, on a procedure note or diagnostic report
Example of Improper Payment due to Insufficient Documentation – Missing documentation to support medical necessity
An orthopedic surgeon billed for HCPCS code 29827 and submitted the following:
• Signed operative report
• Signed pre-operative History and Physical for medical clearance prior to surgery
An additional request for documentation returned no documentation. The submitted records were missing signed clinical documentation to support medical necessity for the billed procedure. Some examples of documentation to support medical necessity may include, but are not limited to: failed conservative treatments prior to the procedure, signed and dated diagnostic imaging reports, or preoperative surgeon notes. The CERT review contractor scored this claim as an insufficient documentation error and the MAC recovered the payment from the provider.
WHAT YOU SHOULD KNOW
Most improper payments for HCPCS code 29827 in this special study were due to insufficient documentation errors. Insufficient documentation means something was missing from the medical records.
Example of Improper Payment due to Insufficient Documentation – Missing documentation to support medical necessity
An orthopedic surgeon billed for HCPCS code 29827 and submitted the following:
• Signed operative report which documented left rotator cuff repair, repair of Superior Labral tear from Anterior to Posterior (SLAP) lesion, and biceps tenotomy
• Unsigned orthopedic surgeon’s note which documented a fall injury with pain in the rotator cuff distribution and weakness in the arm, with tenderness and pain over the distal aspect of the biceps
• Unsigned orthopedic surgeon’s note which documented left shoulder rotator cuff tear via Magnetic Resonance Imaging (MRI) with persistent weakness and failed conservative care measures
• Two unsigned orthopedic surgeon’s post-operative follow-up visit notes An additional request for documentation returned duplicate documentation. The submitted records were insufficient to support the medical necessity for the procedure because the orthopedic surgeon’s clinical documentation was unsigned and a signature attestation was not submitted. Medicare requires that services provided/ordered be authenticated by the author. The provider could have completed a signature attestation to correct this error. The CERT review contractor scored this claim as an insufficient documentation error and the MAC recovered the payment from the provider.
Shoulder arthroscopy procedures include limited debridement (e.g., CPT code 29822) even if the limited debridement is performed in a different area of the same shoulder than the other procedure. With 3 exceptions, shoulder arthroscopy procedures include extensive debridement (e.g., CPT code 29823) even if the extensive debridement is performed in a different area of the same shoulder than the other procedure. 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.
Use CPT code series 23410 to 23412 to report mini open rotator cuff tear repairs, with code selection determined by acute versus chronic conditions. While CPT provides a parenthetical statement under CPT 29827 (Arthroscopy, shoulder, surgical; with rotator cuff repair) directing the CPT user to report 23412 for mini open rotator cuff repair, you still need to determine the final code selection based on the acute versus chronic condition. Recall that CPT code verbiage in 23410 to 23420 is specific to an acute versus chronic condition.
Mini open rotator cuff tear repairs typically don’t involve entry into the shoulder joint while the tear can still be visualized and repaired. When a surgeon performs an arthroscopic rotator cuff repair, report CPT 29827 regardless of whether the condition is acute versus chronic.
The operative report should specify an acute versus chronic condition. The technique (open versus arthroscopic) will need to be apparent to include a detailed description of a repair versus reconstruction of the specific tendon(s) or cuff.
Current Situation
• There are existing CPT codes in which the SN technology fits into – Procedure is billed under CPT Code 29827, Arthroscopic, shoulder, surgical; with rotator cuff repair (see Rotation Medical Coding Guidance for complete list) among other codes
Recent Comments