The Record

We’re making changes to payment policy for debridement procedures billed with arthroscopic procedures

Beginning in December, Blue Cross Blue Shield of Michigan’s payment policy will no longer allow separate and distinct modifiers to bypass bundling claim edits when shoulder debridement procedures are billed with arthroscopic shoulder procedures. If you submit a claim for a debridement procedure and an arthroscopic procedure on the same shoulder, you may receive a denial on the debridement procedure. Even if you append a separate and distinct modifier, bundling edits will still apply.

We’re making this change to help ensure correct coding and payment accuracy.

The following procedure codes apply to this policy:

CPT code

Description

*29806

Arthroscopy, shoulder, surgical; capsulorrhaphy

*29807

Arthroscopy, shoulder, surgical; repair of SLAP lesion

*29819

Arthroscopy, shoulder, surgical; with removal of loose body or foreign body

*29824

Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure)

*29825

Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure)

*29827

Arthroscopy, shoulder, surgical; with rotator cuff repair

*29828

Arthroscopy, shoulder, surgical; biceps tenodesis

*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])

*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])

Exception: Separate reporting of extensive debridement will apply to three arthroscopic CPT codes: *29824, *29827 and *29828.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2022 American Medical Association. All rights reserved.