Resources for Appeals of Shoulder Arthroscopy Denials

Many AAOS members are experiencing denials of code 29826 (Arthroscopy shoulder, surgical decompression of subacromial space with partial acromioplasty, with procedure) when billed in conjunction with codes 29824 and 29827. This is based on medical necessity guidelines developed by AIM. The guidelines state that subacromial decompression/acromioplasty is considered not medically necessary for all indications.

AAOS in conjunction with American Shoulder and Elbow Surgeons (ASES), Arthroscopy Association of North America (AANA), and American Orthopaedic Society for Sports Medicine (AOSSM) are working with AIM to revise these guidelines. Updates will be provided as they become available.

In the meantime, what can you do? Remind the carrier denying your claim that:

• Denial of code 29826 is in direct conflict with AMA CPT Guidelines which designate CPT Code 29826 as an add-on code. The CPT code descriptor clearly states that code 29826 should be listed separately in addition to the code for the primary procedure.
• Parenthetical instruction in CPT also states that code 29826 is to be used in conjunction with codes 29806-29825, 29827, and 29828.
• There are no existing National Correct Coding Initiative (NCCI) edits in place for these code pairs which would preclude one from reporting these codes together.
• The AAOS Global Service Data Guide for Orthopaedic Surgery (GSD) states specifically that codes 29824, 29826, and 29827 are separately reportable.
• Effective January 1, 2020, CMS deleted language from NCCI Policy Manual which stated that the shoulder is a single anatomic structure.

The resources below are intended to provide you with strategic knowledge to support your efforts in appeals for inappropriate denials.