Arthroscopy, shoulder, surgical; decompression of subacromial space
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Shoulder arthroscopy billed without documentation of pathology requiring decompression
Common29826 (arthroscopy shoulder, decompression of subacromial space with partial acromioplasty) requires documentation of impingement syndrome, rotator cuff pathology, or subacromial bursitis necessitating decompression. Denied when diagnostic arthroscopy upgraded to decompression without documented pathology, or when decompression not clearly described.
Common Causes
- • Documentation states 'shoulder arthroscopy performed' without describing decompression procedure
- • No documentation of subacromial impingement or pathology justifying decompression
- • Diagnostic arthroscopy (29805) billed as decompression without actual acromioplasty
Resolution Strategy
Document complete decompression: 'Arthroscopic visualization revealed significant subacromial impingement with inflamed bursa. Partial acromioplasty performed removing anterior-inferior acromion, bursectomy completed, adequate subacromial space decompression confirmed.' Must show: pathology identified, decompression technique, post-decompression result. If only diagnostic scope, rebill 29805. Cannot appeal without documented decompression procedure.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For surgical shoulder arthroscopy with decompression of subacromial space
Common Scenarios
Documentation Requirements
- Indication for subacromial decompression
- Extent of decompression
- Amount of acromion resected
- Decompression technique
- Any complications
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes surgical arthroscopy
- Includes decompression of subacromial space
- Diagnostic arthroscopy bundled when performed same session
- Rotator cuff repair coded separately
- Distal claviculectomy coded separately
Exclusions
- 29805 (arthroscopy, shoulder, diagnostic)
- 29827 (arthroscopy, shoulder, surgical; rotator cuff repair)
- 29824 (arthroscopy, shoulder, surgical; distal claviculectomy)
- 29825 (arthroscopy, shoulder, surgical; lysis and resection of adhesions)
Coding Notes
Clinical scenarios
- Indication for subacromial decompression
- Extent of decompression
- Amount of acromion resected
- Indication for subacromial decompression
- Extent of decompression
- Amount of acromion resected
- Indication for subacromial decompression
- Extent of decompression
- Amount of acromion resected
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Ask a QuestionFrequently Asked Questions
CPT 29826 is the billing code for "Arthroscopy, shoulder, surgical; decompression of subacromial space". For surgical shoulder arthroscopy with decompression of subacromial space
Medicare pays approximately $166.58 for CPT 29826 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 29826 has a total RVU of 25.60, broken down as: Work RVU 11.00, Practice Expense RVU 13.50, and Malpractice RVU 1.10. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 29826 is "Shoulder arthroscopy billed without documentation of pathology requiring decompression". 29826 (arthroscopy shoulder, decompression of subacromial space with partial acromioplasty) requires documentation of impingement syndrome, rotator cuff pathology, or subacromial bursitis necessitating decompression. Denied when diagnostic arthroscopy upgraded to decompression without documented pathology, or when decompression not clearly described. Common causes include: Documentation states 'shoulder arthroscopy performed' without describing decompression procedure; No documentation of subacromial impingement or pathology justifying decompression. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 29826 include: Indication for subacromial decompression; Extent of decompression; Amount of acromion resected; Decompression technique. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 29826: Includes surgical arthroscopy. Includes decompression of subacromial space Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 29826 include: 50 (Bilateral procedure when both shoulders performed same session), 51 (Multiple procedures performed same session), 22 (Increased procedural services for extensive decompression). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 29826 is 50-80 minutes typical operative time. Time-based codes require documentation of the actual time spent providing the service.