29806 only? what about the graft?

jeskla

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Hi,
29827, 29823, 29826 are all bundled according to the CCI edits, so it seems 29806 is all I can bill. Any shoulder specialists out there can would mind taking a look and confirming what I have? It just seems like a lot more work was done than in the laymans CPT description for 29806. There were other posts that said I could possibly bill 15777 for the graft, but I am not sure.

1. Labral repair with allograft (superior capsular reconstruction). 29806
2. Rotator cuff repair with allograft (superior capsular reconstruction). 29827
3. Extensive glenohumeral debridement. 29823
4. Subacromial decompression acromioplasty. 29826

Once the diagnostic arthroscopy was completed, attempts were made to mobilize
the rotator cuff and it was completely absent in the superior portion of the
shoulder. An aggressive debridement was undertaken, removing synovitic
tissue, subacromial bursal tissue and degeneration of the glenoid labrum and
chondroplasty was performed in the humeral head and glenoid as necessary.
This effected an excellent debridement. This allowed room to implant the
graft. Superior aspect of the glenoid and the greater tuberosity were also
debrided down to bleeding bone. On the glenoid side, 4 suture anchors were
placed superiorly and the sutures from these anchors were then passed out
through the dermal allograft. The dermal allograft had been previously
measured to fit the defect in the rotator cuff perfectly. Once the sutures
were passed through the dermal allograft, the allograft was drawn down onto
the superior glenoid and fixed into place by tying the remaining suture ends.
This gave excellent medial row fixation. Four free ends of suture were then
passed through the residual rotator cuff and the rotator cuff was
incorporated into the repair. An excellent medial-sided repair was thereby
obtained. Attention was turned to the lateral side. Three suture anchors
were placed on the greater tuberosity and all 6 sutures from those anchors
were passed through the dermal graft. The graft was marked in such a way
that the sutures were passed through the graft with appropriate tension. All
6 of these sutures were then passed laterally through 2 lateral row anchors
and excellent repair of the lateral aspect of the graft and the rotator cuff
footprint was thereby obtained. Using multiple 3 suture side-to-side, the
posterior aspect of the graft was then affixed to the residual anterior
aspect of the rotator cuff. In this way, the defect in the superior rotator
cuff was completely eliminated and the graft had excellent tension, position,
alignment and fixation. Pictures were taken. The acromion was cleared of
soft tissue and gently flattened with a bur. Instruments were removed and
the wounds were closed with a nylon suture. Sterile dressings were applied.
The patient was awakened from anesthesia and brought to the recovery room in
good condition. There were no complications.
 
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