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Issue Number - Name
0118-Arthroscopic Extensive Shoulder Debridement
Review Type
Automated
Claim Type
Professional Services (Physician/Non-Physician Practitioner)
Region and State
All A/B MACs
Date Approved
2018-10-09

Description

Shoulder arthroscopy procedures includes debridement (e.g., CPT code 29823) even if the debridement is performed in a different area of the same shoulder than the other procedure. Separate reporting of extensive debridement only applies to three CPT codes: 29824, 29827, and 29828. CPT codes 29824, 29827, and 29828 have been excluded from the edit.

Affected Codes

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

Applicable Policy References

Social Security Act (SSA), Section 1833(e) and 1862(a)(1)(A)
42 CFR, Section 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- current