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Subacromial Decompression Coding:
Avoiding Pitfalls and Ensuring Compliance 

By Paul Cadorette, CPC, COC, CPC-P, COSC, CASCC, Director, Training and Education, Coding, nimble solutions



Join Paul Cadorette on March 18th at 1pm Central for ‘The Anatomy of Coding: Shoulder
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Understanding the complexities of billing add-on CPT code +29826 for shoulder arthroscopy, including subacromial decompression with partial acromioplasty and coracoacromial ligament release is critical as it presents unique reimbursement challenges. From a coding standpoint, it’s crucial to approach this correctly to ensure compliance and correct payment.

While maximizing reimbursement is important, adhering to established coding standards is essential. Here, we outline a few issues and the correct coding methodologies to prevent common errors that may pose reimbursement and compliance risks for the add-on CPT code +29826. 

Key Issues with Billing +29826 

  • Some carriers package +29826 into a rotator cuff repair, even though NCCI edits don’t bundle the two.
  • +29826 is an add-on code and doesn’t get reimbursed by Medicare.
  • It bundles into open rotator cuff repairs, limiting billing options.

Understanding Coding Guidelines

In 2012, the AMA clarified that when a subacromial decompression is performed as a stand-alone service, coders should consider using debridement codes 29822 or 29823 based on the extent of the procedure.

However, since January 2021, shoulder debridement guidelines require debridement of three discrete structures to justify coding 29823 which cannot be accomplished by the performance of a subacromial decompression alone. Misapplying these guidelines can lead to improper coding.

Common Coding Errors and Misconceptions

1. Incorrectly Replacing +29826 with 29823 for Medicare Patients:

  • Since Medicare does not reimburse the add-on code +29826, some coders substitute 29823 (a code for extensive arthroscopic debridement of the shoulder joint)  to secure payment. But here’s the problem: Since 2021, 29823 requires debridement of 3 discrete structures without which this substitution is inappropriate.

2. Bypassing Carrier Edits by Changing +29826 to 29823:

  • If a carrier applies a coding edit or packages subacromial decompression (+29826) into a rotator cuff repair, some coders attempt to bypass this by reporting 29823 instead.
  • However, even if the only procedures performed were an open rotator cuff repair and anarthroscopic subacromial decompression, SAD code +29826 inherently bundles into 23410, 23412, and 23420 (rotator cuff repair codes).Replacing +29826 with 29823 in this scenario is not appropriate and violates coding guidelines.

3. Fragmenting Services to Increase Reimbursement:

  • Example: A Medicare patient undergoes an open rotator cuff repair (23412), arthroscopic limited debridement (29822), and subacromial decompression (+29826). Since 29822 and +29826 bundle into 23412, some coders attempt to “move” bursa debridement from +29826 to 29822 and upgrade 29822 to an extensive debridement code 29823.
  • The NCCI Edit Policy Manual strictly prohibits fragmenting a service into component parts just to increase payment. Don’t risk an audit! 

Best Practices for Compliance and Accuracy

  • Understand payer-specific policies regarding SAD +29826.
  • Avoid substituting codes solely to secure reimbursement.
  • Adhere strictly to CPT guidelines and NCCI edits.
  • Stay updated on the latest coding updates and regulatory changes.
  • Physicians should document procedures thoroughly to justify coding selections.

Coding subacromial decompression requires a clear understanding of bundling rules, add-on code policies, and recent guideline changes. If you’re coding +29826, you have two choices: Do it the right way and remain compliant—or take shortcuts which lead to improper billing. Adhering to best practices is the way to go!

 Join our game-changing webinar on March 18, 2025, and become the expert your team needs!