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Issue Number - Name
0117-Automated Arthroscopic Shoulder Limited Debridement
Review Type
Automated
Claim Type
Professional Services (Physician/Non-Physician Practitioner)
Region and State
RACs 1-4
All A/B MACs
Date Approved
2018-10-09

Description

Shoulder arthroscopy procedures include a limited debridement (e.g., CPT code 29822) Code 29822, is not separately payable when another shoulder arthroscopy procedure is billed and paid on the same shoulder for the same day for the same beneficiary at the same encounter.

Affected Code(s)

When CPT code 29822 is billed and paid with one or more of the following CPT codes: 29805, 29806, 29807, 29819, 29820, 29821, 29823, 29824, 29825, 29827, 29828 for the same date of service, for the same beneficiary, for the same shoulder, at the same encounter, if the provider or facility was paid for CPT codes 29805, 29806, 29807, 29819, 29820, 29821, 29823, 29824, 29825, 29827, and/or 29828, then 29822 will be denied.

Applicable Policy References

SSA, Section 1833(e) and 1862(a)(1)(A)
42 CFR, Sections 411.15(k)(1), 424.5(a)(6)
CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 16, Section 20
National Correct Coding Initiative Policy Manual, Chapter 4, E, Effective Date - January 1, 2014