How To Use CPT Code 29826
CPT 29826 refers to an arthroscopic shoulder surgery that consists of decompressing the subacromial space, performing partial acromioplasty and releasing the coracoacromial ligament. The procedure is mostly conducted to alleviate pain and irritation caused by shoulder joint impingement.
The official descriptor of CPT 29826 is: “Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament [ie, arch] release, when performed [List separately in addition to code for primary procedure].”
Short description: Arthroscopic shoulder surgery.
Procedure for CPT Code 29826
The patient is prepared and anesthetized according to standard procedures. The medical provider makes three minor incisions in the area of the shoulder. An arthroscope is then inserted through one of the incisions into the shoulder joint. The provider uses a saline solution to inflate the area around the shoulder joint for better visualization.
Using the arthroscope’s camera, the entire shoulder joint area is visible and accessible. Repairs on the shoulder blade are then conducted to decompress, or relieve pressure on, structures that are abnormally rubbing together. If deemed necessary, a part of the coracoacromial ligament is removed. All these adjustments ultimately help in alleviating the shoulder joint impingement issue. The area is then cleaned, checked for potential bleeding, and the surgical instruments are removed. Lastly, the incisions are sutured closed.
Qualifying circumstances CPT Code 29826
Patients who experience and suffer from shoulder joint impingement, causing pain and inflammation, are qualified to receive the services under CPT code 29826.
This condition can stem from repetitive overhead activities, trauma, or degenerative changes in the shoulder joint. Patients who have not responded positively to conservative treatments such as physical therapy, medication, or corticosteroid injections are typically recommended for the procedure addressed by this CPT code.
When to use CPT Code 29826
It is suitable to bill the 29826 CPT code when the provider performs an arthroscopic shoulder surgery involving decompression of the subacromial space with partial acromioplasty and coracoacromial ligament release.
This code should be used in conjunction with a primary procedure, such as 29806-29825, 29827, or 29828. It should not be reported as an add-on code with open repair codes 23130, 23410, 23415, or 23412.
Documentation requirements
To properly support a claim for CPT 29826, the provider needs to document several crucial pieces of information including the patient’s medical history and physical examination findings, diagnostic imaging results [e.g., X-rays, MRI, or ultrasound], conservative treatments attempted and their outcomes, indications for the surgical procedure, details of the surgical procedure, including instruments used, steps performed, and any complications encountered, and the postoperative care instructions and follow-up plan.
Billing guidelines CPT Code 29826
When billing for CPT code 29826, providers must comply with the specific guidelines and rules set by the payer. This code is an add-on code and must be reported along with a primary procedure [such as 29806-29825, 29827, or 29828]. It should not be reported as an add-on code with open repair codes including 23130, 23410, 23415, and 23412. Essentially, a surgical endoscopy or arthroscopy always includes a diagnostic endoscopy or arthroscopy, hence a diagnostic code should not be used with a surgical one. However, if the provider performs a diagnostic arthroscopy initially and discovers a previously unknown condition requiring open repair, both the open repair and the diagnostic arthroscopy can be reported by adding modifier 59 to the diagnostic arthroscopy.
Historical Information and Similar codes to CPT Code 29826
CPT 29826 was added to the Current Procedural Terminology system on January 1, 1990. The description of code was last updated on January 1, 2012, modifying its previous descriptor of “Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or without coracoacromial release” with the current one. Other similar codes to CPT 29826 are 29806, 29807, 29819, 29822, and 29827, specifically differentiating in the targeted area for repair, or treatment approach applied.
Examples of CPT Code 29826
Various instances fall within the parameters of procedure done using CPT Code 29826. More common cases include those where a patient with a history of shoulder impingement syndrome, persistent shoulder pain, chronic illness, congenital malformation, a major fall or accident, or inherent tendency of developing shoulder impingement undergoes arthroscopic decompression of the subacromial space with partial acromioplasty and coracoacromial ligament release to alleviate pain and irritation.
