2021 ASC Coding Tips: Understanding the Changes to Arthroscopies

By Mandeara Frye, RHIA, CPC, CPMA, CASCC, Director of Coding

Each winter, the Surgical Notes coding leadership team begins preparing for the CPT changes that will go into effect in the new year. This is also a worthwhile best practice for ASCs. In addition to updating your practice management software with the new data set, it’s important to understand the changes and what they may mean for your facility. One of the biggest changes we saw this year involves shoulder arthroscopies.

If your facility performs orthopedic procedures, then you’ve likely already noticed a change in your shoulder arthroscopy coding. The American Medical Association (AMA) changed the code descriptions for arthroscopic shoulder debridement and better defined what constitutes limited versus extensive debridement. The revised codes are as follows (text for emphasis):

• CPT 29822 — Arthroscopy, shoulder, 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, shoulder, surgical; debridement, extensive, 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])

As you can see from the code descriptions, a limited debridement is now defined as 1 or 2 discrete structures and extensive requires debridement of 3 or more discrete structures. In the past, a surgeon could document extensive debridement of one structure and have CPT 29823 reported. However, this has changed for 2021.

It’s also important to note that the structures debrided must still be independent of any other repairs performed. For example, if the biceps tendon is debrided and then followed by a biceps tenodesis, you would not report the debridement.

Another important change to be aware of is a new guideline added to the endoscopy/arthroscopy subsection regarding removal of loose or foreign body(ies). AMA guidelines now state that a loose or foreign body removal may only be reported when the loose/foreign body is equal to or larger than the diameter of the arthroscopic cannula(s) used for the procedure. This means the documentation must clearly state that the arthroscopic portal was enlarged or the cannula changed to a larger one in order to remove the loose or foreign body. This applies to all locations, not just shoulders.

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