Wiki 29823

[pchamp25]

Hi All!
I'm still new to orthopedic coding and I am looking for help regarding CPT 29823. I bill for an ASC facility and after reviewing and provider's note, felt 29823 was supported in the documentation but we have are fighting with the insurance company re: the patient's claim so asked how the professional claim was billed & they felt 29823 was not supported. Here is part of the OP note;

I see 3 distinct structures superior labrum, supraspinatus, and subacrominal space which would support 29823 but am I reading too much into the note? Thoughts on whether documentation supports 29823 or not.
TIA

 

[amyjph]

Was this the entire op note, and was the diagnosis a SLAP tear?

 

[pchamp25]

Was this the entire op note, and was the diagnosis a SLAP tear?

It is the full OP note except the findings paragraph, I have included the findings paragraph below, and a SLAP tear was listed as one of the diagnoses.

 

[amyjph]

If the intent was to go in for the SLAP tear, and the procedure to address that was 23430 (instead of 29828), the labral debridement would be included as/in prep for the tenodesis, so you would not take separate credit for it with 29823. In doing that, you would be down to 2 discrete structures and that would lead you to 29822. Which probably would not be supported. I don't know, it's iffy. They might be seeing it as "clean-up" of the shoulder.

What was your main code billed, 23430? I would probably try to get 23430 & 29822. If the supraspinatus had tearing and there was extensive bursitis subacromial which was debrided = 29822.
If you did 29828 and 29822 that would be an NCCI issue. It's weird with the open/scope thing. I also don't code for facility