Orthopedic Coding Alert

Question: The orthopedic surgeon performed arthroscopic shoulder labral repair and remplissage on the patient’s right shoulder. Below is the procedure description from the op note:

Patient was placed in the lateral decubitus position ensuring all bony prominences well-padded. His neck was in neutral alignment. He was thoroughly cleansed with hydrogen peroxide and subsequently prepped and draped in normal sterile fashion. Surgical time-out was performed with two patient identifiers confirming correct laterality and procedure to be performed. His shoulder joint was insufflated with 60 mL of saline. Posterior portal was established. Diagnostic arthroscopy was commenced with findings of no cartilaginous lesions of the humeral head except for the Hill-Sachs lesion. Subcritical bone loss of the anterior glenoid. Full-thickness anterior labral tear with failure of repair of previous suture anchors or previous suture repair. The Hill-Sachs lesion was identified. I used a curette and bur to create a bleeding bone edge. I then subsequently placed two Arthrex 2.6 fiber tack anchors of the medial and lateral aspects of the Hill-Sachs lesion to tie at the end of the case. I then established the anterior portals. I removed the previous sutures. I created a nice bleeding bone edge of the anterior glenoid with a combination of tissue elevator and a rasp and shaver. A total of four 1.8 knotless fiber tack suture anchors were placed into the labrum and capsule itself. I ensured that I got a large bite of the capsule and prior to tensioning pulled up on the capsule and labrum to create a nice bumper affect. This was achieved with four fiber tack anchors. Pictures were obtained. I then subsequently tied the fiber tack anchors to each other's working stitch to create a compressive effect and placed down the infraspinatus tendon onto the Hill-Sachs lesion thus closing that Hill-Sachs defect. Final pictures were obtained. Portal sites were closed. Xeroform, 4x4, ABD and tape dressing was placed. He was placed into a sling.

I’m not sure what code to report for the remplissage. The provider wants us to bill 29827 or an unlisted code, but after reviewing the op note, I think it should be 29806 appended with modifier 22.

AAPC Forum Subscriber

Answer: You are correct to use 29806 (Arthroscopy, shoulder, surgical; capsulorrhaphy) appended with modifier 22 (Increased procedural services) for the remplissage procedure. Code 29827 (Arthroscopy, shoulder, surgical; with rotator cuff repair) is designated for a rotator cuff repair, which isn’t present in the op note you’ve presented.

Remplissage is a procedure where the surgeon treats posterior capsulodesis and infraspinatus tenodesis arthroscopically. This procedure is typically performed on patients with shoulder instability and Hill-Sachs lesions.

Mike Shaughnessy, BA, CPC, Production Editor, AAPC