Coding Upper Extremity Arthroscopies

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Coding Upper Extremity Arthroscopies

• Becky Zellmer, CPC, MBS, CBCS
• Provider Education
• Prevea Health, Green Bay, WI

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Outline

• Terminology
• Shoulder
• Anatomy
• Diagnostic arthroscopy
• Surgical arthroscopies
• SLAP repairs
• Rotator Cuff Repairs
• Coding generalities
• Elbow
• Anatomy
• Diagnositic arthroscopy
• Surgical arthroscopies
• Wrist
• Anatomy
• Diagnositic arthroscopy
• Surgical arthroscopies
• Carpal Tunnel Release

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Terminology

• Mumford resection of distal clavicle
• Synovectomy removal of synovium
• Capsulorrhaphy suturing of joint capsule
• SLAP Superior labrum from anterior posterior
  tear that occurs along line from biceps tendon
  attachment to superior labrum
• Synovectomy removal of the lining of a joint
• Acromioplasty repair or partial repair of the
  acromion
• Bankhart Bankhart lesion is a detachment of the
  glenoid labrum and sometimes a bone fragment from
  the glenoid

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Shoulder Anatomy
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Arthroscopy, shoulder, diagnostic

• 29805 with or without synovial biopsy (separate
  procedure)
• Usually a component of a more complex service
• Surgical arthroscopy always includes diagnostic
  arthroscopy
• If performed alone, list the code
• If performed with other procedures/services add
  59
• Open 23065-23066, 23100-23101

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Treatment of SLAP lesion

• Debride
• Stabilize
• Excise

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Types of SLAP lesions

• At least seven types are recognized. Types of
  SLAP lesions.
• Type Abnormality
• I Degenerative fraying of the superior portion
  of the labrum, with the labrum remaining
• firmly attached to the glenoid rim
• II Separation of the superior portion of the
  glenoid labrum and tendon of the biceps brachii
• muscle from the glenoid rim labral detachment
• III Bucket-handle tears of the superior portion
  of the labrum without involvement of the
• biceps brachii (long head) attachment
• IV Bucket-handle tears of the superior portion
  of the labrum extending into the biceps tendon
• V Anteroinferior Bankart lesion that extends
  upward to include a separation of the biceps
• tendon
• VI Unstable radial of flap tears associated with
  separation of the biceps anchor

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Pictures of SLAP lesions
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Capsulorrhaphy/SLAP (Surgical)

• 29806 capsulorrhaphy
• Open 23450-23466
• 29807 repair of SLAP lesion
• Can report 29806 with 29807 ONLY if the SLAP
  lesion repair is Type 2 or Type 4 AND there is a
  capsular defect
• Documentation must be very descriptive

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Coding for SLAP repair

• Type I 29822
• Type II 29807
• Type III 29822 or 29807
• Type IV 29807

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Foreign Body/Loose Body (Surgical)

• 29819 with removal of loose body or foreign body
• Open 23040-23044, 23107
• Greater than 5 mm and/or through a separate
  incision to be additionally coded
• Documentation is key

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Synovectomy (Surgical)

• 29820 synovectomy, partial
• Front or back of shoulder (gleno-humeral, AC
  joint or the sub-acromial bursa)
• Open 23105
• 29821 synovectomy, complete
• Front and back of shoulder (2/3 areas/regions)
• Open 23105

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Debridement (Surgical)

• 29822 debridement, limited
• Anterior or posterior part of the gleno-humeral
  joint or the sub-acromial bursa (front or back of
  the shoulder)
• 29823 debridement, extensive
• Both sections of the gleno-humeral joint or in
  any part of the gleno-humeral joint and the
  sub-acromial bursa (front and back of shoulder)

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Claviculectomy (Mumford) (Surgical)

• 29824 distal claviculectomy including distal
  articular surface (Mumford procedure)
• Open 23120
• DO NOT use 23140 this is for excision of tumor
  or bone cyst
• The entire distal clavicle joint surface must be
  excised, not just bone spurs
• Documentation of 1.0cm removed ???
• Does not include repair of rotator cuff or
  arthroscopic acromioplasty

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Adhesions (Surgical)

• 29825 with lysis and resection of adhesions, with
  or without manipulation

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Arthroscopy, shoulder, surgical

• 29826 decompression of subacromial space with
  partial acromioplasty, with or without
  coracoacromial release
• Open 23130 or 23415
• Does not include biceps tenodesis and/or RCR or
  distal clavicle resection

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Rotator Cuff Muscles (4)
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Rotator Cuff Anatomy
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Rotator Cuff Diagnoses

• Acute 3 months or less of symptoms
• Chronic more than 3 months of symptoms or since
  injury

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Rotator Cuff Repair

• 29827 with rotator cuff repair
• Open or mini-open 23412
• NOT INCLUDED
• Scope debridement, limited or extensive other
  than RC
• Scope acromioplasty (29826)
• Distal clavicle resection (29824)
• Remember to document size
• Repair of SLAP lesion
• Biceps tenodesis
• If performed via scope, code unlisted

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Thermal Capsulorraphy

• Only works for a short time
• If performed alone, code 29999
• With another procedure considered included, if
  documentation supports, can code 29999

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Shoulder Coding Generalities

• When arthroscopy is performed in conjunction with
  arthrotomy, append 51
• Converted/Aborted if converted to open, code
  only the open procedure append 22 to support
  the work done via scope
• Rarely paid for arthroscopic portion even with -22

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Shoulder Coding Scenario

• The physician performs a rotator cuff repair,
  subacromial decompression, limited debridement
  and biceps tenotomy arthroscopically. What code
  would you use for the biceps tenotomy?

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Answer

• 29999 (Unlisted procedure, arthroscopy)
• CPT does not yet include a code that describes
  arthroscopic biceps tenotomy
• Use code 23440 (Resection or transplantation of
  long tendon of biceps) for price comparison code

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Shoulder Coding Scenario

• What CPT code do you report if the surgeon
  repairs a Bankart lesion through a scope?

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Answer

• Per AMA, report 29806 (Arthroscopy, shoulder,
  surgicalcapsulorrhaphy)

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Elbow Anatomy
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Arthroscopy, elbow, diagnostic

• 29830 with or without synovial biopsy (separate
  procedure)

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Arthroscopy, elbow, surgical

• 29834 with removal of loose body or foreign body
• 29835 synovectomy, partial
• 29836 synovectomy, complete

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Arthroscopy, elbow, surgical

• 29837 debridement, limited
• 29838 debridement, extensive

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Elbow Coding Scenario

• The surgeon documents
• Arthroscopic extensive debridement, chondroplasty
  and partial synovectomy, anterior compartment
  left elbow
• Arthroscopic extensive debridement, chondroplasty
  and partial synovectomy, posterior compartment
  left elbow

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Answer

• 29838 Arthroscopy, elbow, surgical debridement,
  extensive
• The synovectomy and debridement were performed in
  the same location, therefore, it would not be
  appropriate to code separately. The synovectomy
  is bundled per CCI edits and the use of a
  modifier is not appropriate

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Wrist Anatomy
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Arthroscopy, wrist, diagnostic,

• 29840 with or without synovial biopsy (separate
  procedure)

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Arthroscopy, wrist, surgical

• 29843 for infection, lavage and drainage
• 29844 synovectomy, partial
• 29845 synovectomy, complete

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Arthroscopy, wrist, surgical

• 29846 excision and/or repair of triangular
  fibrocartilage and/or joint debridement
• 29847 internal fixation for fracture or
  instability

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Arthroscopic Carpal Tunnel

• 29848 with release of transverse carpal ligament
• Includes
• Limited tenosynovectomy incidental to procedure
• Division of the transverse carpal ligament
• Neuroplasty
• Not included
• Neuroplasty of ulnar nerve for documented ulnar
  neuropathy
• Open 64721

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Thank you!!

• For questions or comments after the seminar,
  please visit the WMS home page for posting of
  post-conference questions
• Becky Zellmer, CPC, MBS, CBCS
• Provider Education
• Prevea Health, Inc