29827

Arthroscopy, shoulder, surgical; with rotator cuff repair

CPT 29827 describes a surgical arthroscopy of the shoulder specifically to perform a rotator cuff repair. The procedure is performed using a series of small percutaneous portals, typically starting with a posterior portal for the arthroscope to visualize the glenohumeral joint. The surgeon examines the labrum, biceps tendon, and articular surfaces before moving into the subacromial space. The rotator cuff consists of the supraspinatus, infraspinatus, teres minor, and subscapularis. Tears in these tendons can lead to significant pain and weakness, often resulting from acute injury or chronic degeneration. Once the tear is identified, the surgeon uses a shaver and radiofrequency device to debride non-viable tissue and clear the subacromial bursa for better visualization. The humeral head's greater tuberosity, known as the footprint, is prepared by lightly abrading the bone to create a healing response through marrow stimulation. Suture anchors—small devices made of titanium, PEEK, or bio-composite materials—are inserted into the footprint. Using specialized suture passing instruments, the surgeon retrieves the sutures through the tendon in various configurations, such as mattress or simple stitches. These sutures are then tensioned and secured using either arthroscopic knot-tying techniques or knotless fixation devices. This process effectively reapposes the tendon to the bone to facilitate biological healing. The complexity can vary based on tear shape (crescent, U-shaped, or L-shaped) and the degree of tendon retraction. This arthroscopic approach offers the advantages of smaller incisions, less deltoid muscle trauma, and a more comprehensive evaluation of the joint compared to open techniques.

Clinical Indications

  • Full-thickness rotator cuff tears identified on MRI
  • Symptomatic partial-thickness rotator cuff tears failing 3-6 months of conservative therapy
  • Acute traumatic rotator cuff tears in active individuals
  • Shoulder pain and weakness interfering with activities of daily living
  • Impingement syndrome associated with structural rotator cuff damage

Procedure Steps

  1. Patient positioning (beach chair or lateral decubitus) and sterile preparation.
  2. Establishment of posterior portal and insertion of the arthroscope for diagnostic glenohumeral joint survey.
  3. Establishment of lateral and anterior portals for instrumentation.
  4. Debridement of the subacromial space and bursectomy for visualization of the rotator cuff.
  5. Assessment of tear size, shape, and mobility using an arthroscopic grasper.
  6. Preparation of the humeral footprint (greater tuberosity) using a shaver or bone burr.
  7. Insertion of suture anchors into the bone footprint.
  8. Passing of sutures through the rotator cuff tendon using specialized instruments.
  9. Tensioning and securing of the sutures to reappose the tendon to the bone (knot-tying or knotless).
  10. Closure of portals with sutures or adhesive strips.

Coding Guidelines

  • 29827 includes diagnostic arthroscopy (29805); do not report 29805 separately.
  • Limited (29822) or extensive (29823) debridement is bundled into 29827 when performed in the same area.
  • Use add-on code 29826 for subacromial decompression (acromioplasty) when performed with 29827.
  • If a biceps tenodesis is performed arthroscopically, report 29828.
  • For bilateral procedures, append modifier 50.
  • If an open repair is performed instead, use codes 23410 or 23412 instead of 29827.