Subacromial Decompression (29826)

Question:

Our surgeon frequently documents in the procedure title that an arthroscopic subacromial decompression was performed.  We are billing 29826 and are receiving denials from one particular payor stating that the documentation does not support the service.  I am looking at the operative notes associated with these denials and see that in none of the cases did the surgeon document any bony work. Is this required to report this code?

Answer:

Thank you for sharing your experience.  We heard of these denials years ago, so we appreciate  your sharing this information that a payor is again looking  at this code for supportive documentation.  To answer your Question:, yes, CPT code 29826 includes work on the acromion.

Note in the CPT code description, partial acromioplasty is listed as part of the procedure;  this is the ‘bony work’ in your inquiry.

29826  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)

Soft tissue work alone does not meet the definition of this CPT code. Typically, we see documentation similar to ‘an acromioplasty was performed  and reshaped to a type 1 acromion.’ This type of documentation will support the required work for the acromioplasty.  Removal of osteophytes or co-planing of the acromion does not support the partial acromioplasty requirement.

*This response is based on the best information available as of 10/15/20.