How To Use CPT Code 29805

CPT 29805 describes the diagnostic arthroscopy procedure for the shoulder joint, which may or may not include a synovial biopsy. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 29805?

CPT 29805 is used to describe a diagnostic arthroscopy procedure performed on the shoulder joint. This procedure involves the use of an arthroscope, a specialized instrument with a camera, to examine the tissue inside the joint. The provider may also take a sample of the synovial tissue for further analysis and diagnosis. It is important to note that CPT 29805 is specifically for diagnostic purposes and does not include any surgical repair or treatment.

2. Official Description

The official description of CPT code 29805 is: ‘Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure).’ This code is used when the provider performs a diagnostic arthroscopy on the shoulder joint, with or without a synovial biopsy.

3. Procedure

1. The provider begins by preparing the patient and administering anesthesia.
2. Three small incisions are made in the shoulder area to allow access for the arthroscope and other instruments.
3. The arthroscope is inserted through one of the incisions into the shoulder joint.
4. Saline solution is instilled to expand the area around the joint, providing better visibility.
5. The provider uses the camera on the arthroscope to thoroughly examine the shoulder joint, looking for any causes of pain or limitation of motion.
6. If necessary, the provider may take a biopsy of the synovial tissue for further analysis and diagnosis.
7. The ligaments and other structures in the shoulder are inspected.
8. The area is irrigated, checked for bleeding, and any instruments are removed.
9. The incisions are closed, typically with sutures or adhesive strips.

4. Qualifying circumstances

CPT 29805 is performed on patients who require a diagnostic examination of the shoulder joint. This may be due to symptoms such as pain, limited range of motion, or suspected underlying conditions. The procedure is typically performed by a qualified healthcare professional, such as an orthopedic surgeon or sports medicine specialist, who has the necessary training and expertise in arthroscopy. It is important to note that CPT 29805 is specifically for diagnostic purposes and should not be used for surgical repair or treatment.

5. When to use CPT code 29805

CPT code 29805 should be used when a diagnostic arthroscopy procedure is performed on the shoulder joint. This code is appropriate when the provider is examining the joint for diagnostic purposes, with or without a synovial biopsy. It is important to note that CPT 29805 should not be used for surgical repair or treatment procedures, as there are separate codes available for those purposes.

6. Documentation requirements

To support a claim for CPT 29805, the provider must document the following information:

• Reason for the diagnostic arthroscopy procedure
• Details of the procedure, including the use of an arthroscope and any additional instruments
• Whether a synovial biopsy was performed, if applicable
• Findings from the examination, including any abnormalities or suspected conditions
• Any additional actions taken during the procedure, such as irrigation or closure of incisions
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 29805, it is important to ensure that the procedure performed is a diagnostic arthroscopy of the shoulder joint. This code should not be used for surgical repair or treatment procedures. It is also important to follow any specific guidelines or requirements set by the payer or insurance company. Additionally, if a synovial biopsy is performed as a separate procedure, it should be reported with the appropriate code. It is important to review the documentation and accurately report the services provided to ensure proper reimbursement.

8. Historical information

CPT 29805 was added to the Current Procedural Terminology system on January 1, 2002. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient presents with persistent shoulder pain and limited range of motion. The provider performs a diagnostic arthroscopy to examine the shoulder joint and identify any underlying causes of the symptoms.
2. Following a sports injury, a patient experiences recurrent shoulder instability. The provider performs a diagnostic arthroscopy to assess the integrity of the shoulder joint and determine the appropriate treatment plan.
3. A patient with suspected rotator cuff tear undergoes a diagnostic arthroscopy to confirm the diagnosis and assess the extent of the injury.
4. A patient with chronic shoulder inflammation undergoes a diagnostic arthroscopy to evaluate the synovial tissue and determine the appropriate course of treatment.
5. A patient with a history of shoulder dislocations presents with ongoing instability. The provider performs a diagnostic arthroscopy to assess the stability of the shoulder joint and identify any contributing factors.
6. A patient with persistent shoulder pain and suspected labral tear undergoes a diagnostic arthroscopy to evaluate the labrum and determine the appropriate treatment approach.
7. A patient with a history of shoulder trauma presents with ongoing pain and limited mobility. The provider performs a diagnostic arthroscopy to assess the joint and identify any underlying structural abnormalities.
8. A patient with suspected shoulder impingement syndrome undergoes a diagnostic arthroscopy to evaluate the joint and determine the appropriate treatment plan.
9. A patient with chronic shoulder instability and recurrent dislocations undergoes a diagnostic arthroscopy to assess the joint and identify any contributing factors.
10. A patient with persistent shoulder pain and suspected joint inflammation undergoes a diagnostic arthroscopy to evaluate the joint and determine the appropriate course of treatment.