As my interest in CPT® coding continues to grow, I make it a point to explore areas of commonly used codes and procedures. I chose the shoulder as my area of interest for this article because it is a commonly treated region whether for athletes or the everyday Jane or John Doe who injures their shoulder during a workout or a fall. As someone who also enjoys history, I was intrigued to see when these procedures were first developed and by whom, since this perspective provides a clear path to understanding how far technology and both diagnostic and surgical practices have progressed.
Shoulder arthroscopy has transformed the way orthopedic surgeons diagnose and treat these conditions. What began as a diagnostic tool has evolved into a cornerstone of minimally invasive surgery, offering both precision and improved patient outcomes. Exploring the history of arthroscopic shoulder procedures reveals how these early advancements laid the foundation for many of the techniques used today. This historical perspective adds important context as we examine the CPT® codes that represent these services.
In this article, my focus is on CPT® code range 29805–29828, which includes both diagnostic and surgical shoulder arthroscopies. These procedures range from diagnostic exams and capsulorrhaphy to SLAP repairs, synovectomies, debridement, distal claviculectomy, subacromial decompression, rotator cuff repair, and related interventions. Together, this code range illustrates the progression of shoulder arthroscopy from basic visualization to complex reconstructive surgery.
In this article I will discuss the following:
- History of Arthroscopic Shoulder Procedures
- Anatomy of the Shoulder
- NCCI’s Policy Manual Chapter IV (E. Arthroscopy)
- CPT Codes 29805-29828 and their description
- Modifier guidelines/ Global and Other Information
- ICD-10-CM Crosswalks
- Coding scenario to visualize how the codes are applied based on physician documentation
History of Arthroscopic Shoulder Procedures
The origins of arthroscopy trace back to Thomas Edison’s invention of the incandescent bulb in 1879, which made possible the first cystoscope developed by Leiter and Nitz in 1886. In 1912, Severin Nordentoft expanded this innovation by using an endoscope to examine the knee joint, laying the foundation for modern arthroscopy. Building upon these early advances, Kenji Takagi’s pioneering work in Japan led to the creation of the first true arthroscope, later refined into the Watanabe arthroscope in the late 1930s. A major turning point occurred in the mid-20th century when Harold Hopkins introduced fiber optics and the rod lens system, transforming arthroscopy into a versatile tool across surgical specialties.
Shoulder arthroscopy was first introduced in 1931 when American surgeon Michael S. Burman performed it in a diagnostic capacity during cadaveric studies. The first documented clinical use of shoulder arthroscopy appeared in 1965 in the treatment of adhesive capsulitis. During the 1980s, James Andrews and Harvard Ellman played a major role in popularizing the technique, particularly for rotator cuff debridement and subacromial decompression in orthopedic surgery. Advancements throughout the 1980s and 1990s expanded the role of shoulder arthroscopy to include procedures for shoulder instability, such as arthroscopic Bankart repair. Since then, the field has continued to grow, with shoulder arthroscopy now widely used for treating shoulder instability, fractures of the humerus and glenoid, rotator cuff repair, and numerous other soft-tissue pathologies.
What is an Arthroscopy?
Arthroscopy is a minimally invasive procedure that uses a fiber-optic camera to both diagnose and treat joint conditions. During the procedure, a surgeon makes a small incision about the size of a buttonhole and inserts a thin tube with a camera attached. This provides a clear, high-definition view of the inside of the joint on a video monitor.
One of the key benefits of arthroscopy is that it allows the surgeon to examine the joint without the need for a large incision. In many cases, the surgeon can also perform repairs using specialized pencil-thin instruments that are inserted through additional tiny incisions.
What is Shoulder Arthroscopy?
Shoulder arthroscopy is a minimally invasive surgical procedure used to both diagnose and treat problems inside the shoulder joint. It is often performed in conditions such as rotator cuff tears or shoulder impingement. Unlike traditional surgery, arthroscopy requires only small incisions each about the size of a keyhole.
During the procedure, the surgeon inserts a tiny camera called an arthroscope through one of these incisions. The arthroscope projects real-time images of the shoulder joint onto a video screen, allowing the surgeon to carefully examine the structures inside. If repair is needed, miniature surgical instruments are inserted through additional small incisions to restore function and mobility.
Why is Shoulder Arthroscopy Performed?
Shoulder arthroscopy is recommended when shoulder pain or dysfunction does not improve with nonsurgical treatments such as physical therapy, medications, injections, or rest. It allows providers to both identify the exact cause of pain and, when possible, treat the problem in the same procedure.
Shoulder arthroscopy can address a wide range of injuries and disorders, including:
- Biceps tendon injuries
- Bone spurs
- Frozen shoulder
- Labrum tears (injuries to the cartilage surrounding the socket)
- Osteoarthritis
- Rotator cuff tears
- Rotator cuff tendinitis
- Shoulder impingement syndrome
- Shoulder instability (looseness or dislocation of the joint)
Anatomy of the Shoulder
Parts of the Shoulder
- Bony framework
- Scapula
- Clavicle
- Humerus
- Joints
- Glenohumeral (ball-and-socket synovial joint)
- Acromioclavicular (AC) joint
- Sternoclavicular (SC) joint – atypical synovial joint with fibrocartilage disc
- Scapulothoracic joint – physiological joint formed by gliding of acromion over clavicle
- Stabilizing structures
- Rotator cuff muscles: supraspinatus, infraspinatus, subscapularis, teres minor
- Joint capsules lined with synovial membrane
- Hyaline cartilage covering articular surfaces
- Main movements
- Flexion
- Extension
- Abduction
- Adduction
- Internal rotation
- External rotation
- Functional notes
- Movements usually involve the glenohumeral, sternoclavicular, and acromioclavicular joints together
- Elevation of the arm especially depends on coordinated joint action
- Range of motion varies by age, sex, health conditions, and dominance of the arm
The shoulder joint is among the most mobile in the human body, and any restriction of its movement can significantly impair functional ability. Clinicians in primary care, orthopedics, and rheumatology are tasked with evaluating shoulder complaints in a systematic way. To accurately identify the source of pathology, a solid understanding of the shoulder girdle’s anatomy and related structures is essential.
The shoulder’s anatomy is complex, combining bony, muscular, and ligamentous elements that together allow a wide range of motion while still preserving joint stability. The bony framework of the shoulder girdle consists of the scapula, clavicle, and humerus. These articulate at the glenohumeral and acromioclavicular (AC) joints, both of which are synovial joints. Each is enclosed in a capsule lined with synovial membrane, and their articular surfaces are covered with hyaline cartilage. Medially, the clavicle connects to the manubrium of the sternum at the sternoclavicular (SC) joint an atypical (not typical or unusual) synovial joint distinguished by a wedge of fibrocartilage between its surfaces.
In addition, the scapulothoracic joint functions as a physiological joint, with movement produced by the gliding of the acromion over the clavicle. The rotator cuff comprising the supraspinatus, infraspinatus, subscapularis, and teres minor forms the primary stabilizing structure of the glenohumeral joint. Together, these joints operate individually and in coordination to generate the composite movements of the shoulder. These actions are critical for positioning the upper limb with precision, enabling the fine motor activities required in daily function. The main movements of the shoulder include flexion, extension, abduction, adduction, internal rotation, and external rotation. The range of these movements can vary depending on factors such as age, sex, underlying conditions, and whether the arm is dominant or non-dominant. Any time the humerus moves at the shoulder joint, it almost always involves not just the glenohumeral joint but also the sternoclavicular and acromioclavicular joints. This is especially true during elevation of the arm.
NCCI Policy Manual – Chapter IV (E. Arthroscopy)
Diagnostic vs. Surgical Arthroscopy
- A surgical arthroscopy includes diagnostic arthroscopy and is not separately reportable
- If a diagnostic arthroscopy leads directly to a surgical arthroscopy during the same encounter, report only the surgical arthroscopy
Arthroscopy to Assess Surgical Field
- If arthroscopy is performed solely to evaluate the surgical field or extent of disease, it is not separately reportable
- If findings from a diagnostic arthroscopy leads to an open procedure, the diagnostic arthroscopy may be separately reported
- Modifier 58 may be reported to show that the diagnostic arthroscopy and the non-arthroscopic therapeutic procedure were staged or planned
- Documentation must clearly support medical necessity for diagnostic arthroscopy
Conversion to Open Procedure
- If an arthroscopic procedure is converted to an open procedure, only the open procedure is reported.
- Do not report a surgical or diagnostic arthroscopy code along with the open procedure.
NCCI PTP Edit Code Pairs – Shoulder
- Except for specific exceptions (see Arthroscopy Subsection 7), 2 codes describing 2 shoulder arthroscopy procedures are not to be bypassed with an NCCI PTP- modifier when performed on the ipsilateral (belonging to the same side of the body) shoulder
- NCCI PTP Edits may only be used if the two procedures are performed on contralateral (opposite or related to opposite side of the body) shoulders.
Arthroscopic Debridement – Same Joint
- Except for the knee and shoulder, arthroscopic debridement is not separately reportable with a surgical arthroscopy on the same joint during the same encounter.
- For shoulder debridement, see Subsection 7.
Subsection 7: Shoulder Arthroscopy Debridement
- Shoulder arthroscopy codes include limited debridement (29822), even if the limited debridement is performed in another area of the same shoulder, then the other procedure being performed
- Shoulder arthroscopy codes also include extensive debridement (29823) even if the extensive debridement is performed in a different area of the other procedure being performed, with three exceptions:
• 29824 (Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface- Mumford procedure)
• 29827 Arthroscopy, shoulder, surgical; with Rotator cuff repair)
• 29828 (Arthroscopy, shoulder, surgical; Biceps tenodesis) - These three codes may be reported separately with 29823 if the extensive debridement is performed in a different area of the same shoulder.
CPT® Codes 29805–29828: Arthroscopic Shoulder Procedures
The CPT® code range 29805–29828 captures the full spectrum of diagnostic and surgical arthroscopic procedures of the shoulder. These codes represent the progression of arthroscopy from its origins in diagnostic evaluation (29805) to its application in complex surgical interventions such as capsulorrhaphy, SLAP lesion repair, synovectomy, debridement, distal claviculectomy, subacromial decompression, rotator cuff repair, and biceps tenodesis. Each code provides a precise description of the specific service performed, ensuring accurate reporting, compliance with coding guidelines, and proper reimbursement. The table below outlines the official CPT® descriptors, notes, and related coding instructions for these commonly reported arthroscopic shoulder procedures.
| CPT® Code | Official Code Descriptor & Notes |
| 29805 | Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure) Notes: (For open procedure, see 23065-23066, 23100-23101) |
| 29806 | Arthroscopy, shoulder, surgical; capsulorrhaphy Notes: (For open procedure, see 23450-23466) (To report thermal capsulorrhaphy, use 29999) |
| 29807 | Arthroscopy, shoulder, surgical; repair of SLAP lesion |
| 29819 | Arthroscopy, shoulder, surgical; with removal of loose body or foreign body Notes: (For open procedure, see 23040-23044, 23107) |
| 29820 | Arthroscopy, shoulder, surgical; synovectomy, partial Notes: (For open procedure, see 23105) |
| 29821 | Arthroscopy, shoulder, surgical; synovectomy, complete Notes: (For open procedure, see 23105) |
| 29822 | Arthroscopy, shoulder, surgical; debridement, limited, 1 or 2 discrete structures (e.g., humeral bone/cartilage, glenoid bone/cartilage, biceps tendon, labrum, capsule, rotator cuff surfaces, bursa, foreign body[ies]) Notes: (For open procedure, see specific open shoulder procedure performed) |
| 29823 | Arthroscopy, shoulder, surgical; debridement, extensive, 3 or more discrete structures (same list as 29822) Notes: (For open procedure, see specific open shoulder procedure performed) |
| 29824 | Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure) Notes: (For open procedure, use 23120) |
| 29825 | Arthroscopy, shoulder, surgical; with lysis and resection of adhesions, with or without manipulation Notes: (For open procedure, see specific open shoulder procedure performed) |
| 29826 ✚ | Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (arch) release, when performed (List separately in addition to code for primary procedure) Notes: (For open procedure, use 23130 or 23415) (Use 29826 in conjunction with 29806-29825, 29827, 29828) |
| 29827 | Arthroscopy, shoulder, surgical; with rotator cuff repair Notes: (For open or mini-open rotator cuff repair, use 23412) (When arthroscopic distal clavicle resection is performed at the same setting, use 29824 and append modifier 51) |
| 29828 | Arthroscopy, shoulder, surgical; biceps tenodesis Notes: (Do not report 29828 in conjunction with 29805, 29820, 29822) (For open biceps tenodesis, use 23430) |
Modifier Guidelines / Global and Other Information
CPT® 29805 Global & Other Information
CPT® code 29805 (Arthroscopy, shoulder, diagnostic, with or without synovial biopsy) has specific reimbursement and time distribution rules under the Medicare Physician Fee Schedule. The percentages reflect how much of the Relative Value Units (RVUs) are attributed to each portion of the procedure, and the global period defines how long follow-up is bundled into the original payment.
| Category | Value |
| Preoperative % | 10% |
| Intraoperative % | 69% |
| Postoperative % | 21% |
| Total RVU | 100 |
| Global Period (days) | 090 |
| Radiology Diagnostic Tests | 99 |
| PC/TC Indicator | 0 |
| Endoscopic Base Code | None |
Modifier Guidelines for CPT® 29805
Certain modifiers may or may not apply when reporting CPT® 29805. These guidelines help coders determine correct billing practices, prevent improper payments, and maintain compliance with Medicare and NCCI policies.
| Modifier | Description | Rule / Applicability |
| 51 | Multiple Procedures | Multiple procedure reduction applies |
| 50 | Bilateral Surgery | 150% bilateral adjustment applies |
| 80 | Assistant Surgeon | Assistant payment not allowed |
| 62 | Co-Surgeon | Allowed when documentation supports |
| 66 | Team Surgeon | Not permitted |
| 81 | Minimum Assistant Surgeon | Assistant payment not allowed |
| 82 | Assistant Surgeon (Qualified Resident Not Avail.) | Assistant payment not allowed |
| *PS | Physician Supervision | Concept does not apply |
ICD-10-CM Crosswalks
The shoulder is one of the most complex joints in the body, and a variety of disorders can affect its stability, function, and range of motion. Accurate ICD-10-CM coding is essential for documenting these conditions, guiding treatment, and ensuring proper reimbursement. The table below highlights a selection of commonly used shoulder-related ICD-10-CM codes, covering articular cartilage disorders, ligament conditions, dislocations, contractures, stiffness, injuries, impingement syndromes, and synovitis.
This table is not an exhaustive list of ICD-10-CM codes for shoulder conditions. It is provided as an example of commonly referenced codes for documentation, coding, and educational purposes.
| Code | Description |
| M24.111 | Other articular cartilage disorders, right shoulder |
| M24.211 | Disorder of ligament, right shoulder |
| M24.411 | Recurrent dislocation, right shoulder |
| M24.511 | Contracture, right shoulder |
| M25.611 | Stiffness of right shoulder, not elsewhere classified |
| M25.811 | Other specified joint disorders, right shoulder |
| S46.891A | Other injury of other muscles, fascia and tendons at shoulder and upper arm level, right arm, initial encounter |
| M75.41 | Impingement syndrome of right shoulder |
| M75.42 | Impingement syndrome of left shoulder |
| M65.811 | Other synovitis and tenosynovitis, right shoulder |
| M65.812 | Other synovitis and tenosynovitis, left shoulder |
| S42.012A | Anterior displaced fracture of sternal end of left clavicle, initial encounter for closed fracture |
| S42.191A | Fracture of other part of scapula, right shoulder, initial encounter for closed fracture |
| M75.100 | Unspecified rotator cuff tear or rupture of unspecified shoulder, not specified as traumatic |
| M75.101 | Unspecified rotator cuff tear or rupture of right shoulder, not specified as traumatic |
| M75.102 | Unspecified rotator cuff tear or rupture of left shoulder, not specified as traumatic |
| M75.121 | Complete rotator cuff tear or rupture of right shoulder, not specified as traumatic |
| M19.01 | Primary osteoarthritis, shoulder |
| M19.011 | Primary osteoarthritis, right shoulder |
| M19.012 | Primary osteoarthritis, left shoulder |
| M19.019 | Primary osteoarthritis, unspecified shoulder |
| S43.431A | Superior glenoid labrum lesion of right shoulder, initial encounter |
Coding Scenario
Operative Procedure Report:
Preoperative Diagnosis:
- Complete rotator cuff tear of right shoulder, not specified as traumatic (M75.121)
Postoperative Diagnosis:
- Complete rotator cuff tear of right shoulder, not specified as traumatic (M75.121)
Procedure Performed:
- Arthroscopic rotator cuff repair (29827)
- Arthroscopic shoulder debridement, limited (29822)
Procedure Description:
The patient was brought to the operating room and placed in the beach-chair position. After sterile preparation and draping, standard arthroscopic portals were created. Diagnostic arthroscopy of the right shoulder confirmed a complete rotator cuff tear, along with degenerative tissue requiring limited debridement.
Using arthroscopic instruments, limited debridement was performed, removing frayed tissue involving the humeral cartilage and rotator cuff surfaces. Attention was then directed to the rotator cuff tear. The tendon was mobilized, and suture anchors were placed into the greater tuberosity of the humerus. The torn tendon was secured back to its anatomic footprint, achieving a stable repair. Adequate fixation and restoration of cuff integrity were confirmed arthroscopically.
The joint was irrigated, instruments were removed, portals were closed, and sterile dressings were applied. The patient tolerated the procedure well and was transferred to recovery in stable condition.
Code Assignment
- ICD-10-CM
- M75.121 – Complete rotator cuff tear or rupture of right shoulder, not specified as traumatic
- CPT
- 29827 – Arthroscopy, shoulder, surgical; with rotator cuff repair
🛑 Take note: If the provider had documented the debridement as extensive in a different area of the same shoulder, CPT® code 29823 would have been reported in addition to 29827. It is imperative when performing CPT® coding to use an NCCI checker to avoid unbundling or overreporting services, thereby ensuring compliance.
Closing Thoughts
Shoulder arthroscopy has evolved from a simple diagnostic technique into a highly advanced surgical approach that allows providers to address a wide range of conditions with precision and minimal disruption. From its early origins in the 20th century to the modern techniques we use today, arthroscopy reflects both the innovation of medical technology and the growing demand for procedures that balance effectiveness with faster recovery times.
For coders, understanding this progression is just as important as recognizing the anatomy of the shoulder itself. Each CPT® code in the 29805–29828 range represents not just a procedure, but also a piece of this surgical evolution from diagnostic visualization to complex reconstructive repairs. Pairing these codes with accurate ICD-10-CM crosswalks ensures that documentation tells the full story of a patient’s condition and treatment, while also meeting compliance standards set forth by NCCI guidelines.
Ultimately, coding for shoulder arthroscopy requires both clinical awareness and technical precision. By studying the anatomy, procedures, policy guidance, and coding rules side by side, coders can build confidence in assigning the correct codes and supporting medical necessity. This article aimed to highlight that journey linking history, anatomy, CPT® coding, ICD-10-CM crosswalks, and real-world scenarios so that we, as coding professionals, can continue to strengthen our role in advancing accurate documentation and quality patient care.
Works Cited
• CPT® 2025 Professional Edition. American Medical Association, 2025.
• ICD-10-CM Coding Expert 2025. AAPC, 2025.
• Codify. AAPC, http://www.aapc.com/codify.
• Chapter IV: Surgery – Musculoskeletal System, Medicare National Correct Coding Initiative Policy Manual. Centers for Medicare & Medicaid Services.
• “Arthroscopy.” Mayo Clinic, www.mayoclinic.org/tests-procedures/arthroscopy/about/pac-20392974.
• “Shoulder Arthroscopy: Procedure, What to Expect, and Recovery.” Cleveland Clinic, my.clevelandclinic.org/health/treatments/21785-shoulder-arthroscopy.
• “The Evolution of Arthroscopic Shoulder Surgery: Current Trends and Future Perspectives.” PubMed Central (PMC), U.S. National Library of Medicine, https://pmc.ncbi.nlm.nih.gov/articles/PMC7879187/.