How To Use CPT Code 29806

CPT 29806 refers to an arthroscopic shoulder surgery procedure called capsulorrhaphy, and this article will cover its description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.

1. What is CPT 29806?

CPT 29806 is a medical billing code used to describe a specific type of arthroscopic shoulder surgery called capsulorrhaphy. This procedure involves the examination and repair of the shoulder joint capsule using an arthroscope and additional instruments. Medical coders and billers use this code to accurately document and bill for this surgical procedure.

2. 29806 CPT code description

The official description of CPT code 29806 is: “Arthroscopy, shoulder, surgical; capsulorrhaphy.”

3. Procedure

The 29806 procedure involves the following steps:

1. The patient is prepped and anesthetized.
2. The provider makes three small incisions in the shoulder area.
3. An arthroscope is inserted through one of the incisions into the shoulder joint.
4. Saline solution is instilled to expand the area around the shoulder joint.
5. The provider views the entire shoulder joint area using the camera of the scope.
6. Additional instruments are inserted, and the torn joint capsule is repaired.
7. The provider inspects the ligaments and other structures in the shoulder.
8. The area is irrigated, checked for bleeding, and instruments are removed.
9. The incisions are closed.

4. Qualifying circumstances

Patients eligible to receive CPT code 29806 services are those who have a torn shoulder joint capsule, which can be caused by falling on an outstretched arm, a twisting injury, or a forceful blow to the shoulder area. This condition can lead to shoulder dislocation and may require surgical intervention to repair the damaged joint capsule and restore shoulder function.

5. When to use CPT code 29806

It is appropriate to bill the 29806 CPT code when a provider performs an arthroscopic capsulorrhaphy to repair a torn shoulder joint capsule. This code should not be used for diagnostic arthroscopy or open repair procedures. If a diagnostic arthroscopy is performed and an open repair is required, the appropriate open repair code should be billed along with the diagnostic arthroscopy code, using modifier 59 to indicate a distinct procedural service.

6. Documentation requirements

To support a claim for CPT 29806, the following information should be documented:

• Patient’s medical history and physical examination findings
• Indication for the procedure, including the diagnosis of a torn shoulder joint capsule
• Description of the surgical procedure, including the use of an arthroscope and additional instruments
• Findings during the procedure, such as the extent of the joint capsule tear and any other abnormalities
• Details of the repair performed, including the techniques used and any complications encountered
• Postoperative care instructions and follow-up plan

7. Billing guidelines

When billing for CPT code 29806, it is important to follow the appropriate guidelines and rules. Surgical endoscopy or arthroscopy always includes a diagnostic endoscopy or arthroscopy, so a diagnostic code should not be used with a surgical code. If the provider performs a diagnostic arthroscopy and discovers the need for an open repair, both the open repair code and the diagnostic arthroscopy code can be reported with modifier 59. If the provider schedules an arthroscopic capsulorrhaphy and an open rotator cuff repair during the same operative session, both codes can be billed if the separate approaches are justified in the operative notes.

8. Historical information

CPT 29806 was added to the Current Procedural Terminology system on January 1, 2002. There have been no updates to the code since its addition.

9. Similar codes to CPT 29806

Five similar codes to CPT 29806 and how they differentiate from it are:

• CPT 29807: This code is used for arthroscopic shoulder surgery involving the repair of a torn labrum.
• CPT 29819: This code is used for arthroscopic shoulder surgery involving the removal of loose bodies or foreign material.
• CPT 29821: This code is used for arthroscopic shoulder surgery involving the removal of inflamed synovial tissue.
• CPT 29822: This code is used for arthroscopic shoulder surgery involving the removal of bone spurs or other bony abnormalities.
• CPT 29823: This code is used for arthroscopic shoulder surgery involving extensive debridement of the shoulder joint.

10. Examples

Here are 10 detailed examples of CPT code 29806 procedures:

1. A patient with a history of recurrent shoulder dislocations undergoes arthroscopic capsulorrhaphy to repair the torn joint capsule and stabilize the shoulder.
2. A patient with a shoulder joint capsule tear caused by a sports injury undergoes arthroscopic capsulorrhaphy to repair the damage and restore shoulder function.
3. A patient with a chronic shoulder joint capsule tear that has not improved with conservative treatment undergoes arthroscopic capsulorrhaphy to repair the tear and alleviate pain.
4. A patient with a shoulder joint capsule tear and associated labral tear undergoes arthroscopic capsulorrhaphy and labral repair (CPT 29807) during the same operative session.
5. A patient with a shoulder joint capsule tear and associated rotator cuff tear undergoes arthroscopic capsulorrhaphy and open rotator cuff repair (CPT 23412) during the same operative session, with separate approaches justified in the operative notes.
6. A patient with a shoulder joint capsule tear undergoes diagnostic arthroscopy (CPT 29805), which reveals the need for an open repair. The provider performs an open capsulorrhaphy (CPT 23450) and bills both codes with modifier 59.
7. A patient with a shoulder joint capsule tear and associated synovitis undergoes arthroscopic capsulorrhaphy and synovectomy (CPT 29821) during the same operative session.
8. A patient with a shoulder joint capsule tear and associated loose bodies undergoes arthroscopic capsulorrhaphy and removal of loose bodies (CPT 29819) during the same operative session.
9. A patient with a shoulder joint capsule tear and associated bone spurs undergoes arthroscopic capsulorrhaphy and removal of bone spurs (CPT 29822) during the same operative session.
10. A patient with a shoulder joint capsule tear and extensive joint damage undergoes arthroscopic capsulorrhaphy and extensive debridement (CPT 29823) during the same operative session.