Arthroscopic Subacromial Decompression (SAD) Defense Letter
Posted 1/28/2026
As part of the AANA’s ongoing Advocacy efforts, and in collaboration with the American Orthopaedic Society for Sports Medicine (AOSSM), Advocacy Committee Chair, Dr. Patrick Joyner led the development of a support letter designed to assist surgeons with documentation and reporting of arthroscopic subacromial decompression (SAD). Indications frequently associated with SAD – such as os acromiale, tumor, and fracture – are not supported by current evidence and do not reflect the procedure’s established role in treating mechanical impingement or serving as an adjunct to rotator cuff repair in select, high-risk patients. These inconsistencies have increased peer-to-peer review challenges and administrative friction for surgeons.
The support letter clarifies the evidence-based clinical rationale for SAD, helping surgeons clearly articulate appropriate indications and support surgical requests during peer-to-peer discussions. This resource is now available for download on AANA’s Coding Resources page and may be submitted alongside surgical requests as supplemental documentation. The letter has been endorsed by the 2026 AANA Presidential Line and reflects a unified, evidence-based approach to improving documentation, and most importantly patient care.