It was a busy first half of the year. The SIS Revenue Cycle Services team has been hard at work ensuring our clients receive their correct payments in a timely manner. Critical to our success is the proper coding of procedures.
In this blog, I am highlighting a couple of noteworthy updates made by the American Medical Association (AMA) to CPT codes and documentation rules for 2021 that you may have missed. I'll then share quick tips about the continued importance of documenting excision and repair sizes.
Limited Vs. Extensive Arthroscopic Shoulder Debridement
In 2021, the AMA updated the definition of limited (CPT 29822) and extensive (CPT 29823) arthroscopic shoulder debridement to include details about the documentation requirements of limited debridement compared to extensive debridement.
The revised definitions are as follows:
CPT 29822 — Arthroscopy, surgical; debridement, limited, 1 or 2 discrete structures (e.g., humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body(ies))
CPT 29823 — Arthroscopy, surgical; debridement, extended, 3 or more discrete structures (e.g., humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body(ies))
The previous code descriptions were vague and left a lot to interpretation:
- CPT 29822 — Arthroscopy, shoulder, surgical; debridement, limited
- CPT 29823 — Arthroscopy, shoulder, surgical; debridement, extensive
What contributed to the confusion around these codes is that the guidance from the AMA and the American Academy of Orthopaedic Surgeons (AAOS) was that CPT 29822 included debridement of soft or hard tissue in a single area of the shoulder and CPT 29823 included debridement of multiple soft structures, multiple hard structures, or a combination of both. Physicians would often say they extensively debrided the labrum or the rotator cuff and believe this was considered an extensive debridement.
Arthroscopic Loose Body Removal
The AMA also added coding guidance to its arthroscopic subsection guidelines in the 2021 CPT manual that addressed separate reporting of arthroscopic loose body removal. This guidance applies to all joints and associated loose body removal codes: CPT 29819, CPT 29834, CPT 29861, CPT 29874, CPT 29894, and CPT 29904.
Here is the CPT subsection guideline:
- Arthroscopic removal of loose body(ies) or foreign body(ies) (i.e. 29819, 29834, 29861, 29874, 29894, 29904) may be reported only when the loose body(ies) or foreign body(ies) is equal to or larger than the diameter of the arthroscopic cannula(s) used for the specific procedure – and can only be removed through a cannula larger than that used for the specific procedure or through a separate incision or through a portal that has been enlarged to allow removal of the loose or foreign body(ies).
To properly report the procedure, it is essential to document the details of the work performed to remove the loose/foreign body based upon these guidelines.
Excision and Repair Sizes
Finally, we find that reviewing the rules concerning documenting excision and repair sizes is always worthwhile, as documenting these sizes is often essential to getting paid and avoiding denials.
Numerous procedures require documentation of size. They include the following:
In the integumentary system:
- The size of any lesion excision must include the size of the lesion.
- The size of any repair, adjacent tissue transfer, flap, or graft must be documented.
In the musculoskeletal system:
- The size of any tumor excised, as well as the deepest tissue dissected for the tumor (e.g. subcutaneous, subfascial, intramuscular) must be documented.
In the urinary system:
- The size of tumors excised or fulgurated must be documented.
- In cystourethroscopy with litholapaxy, the size of the bladder calculus must be documented.
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