29806 or 29807 with 29822

Shay2025

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OP Report:
We began by inserting the 30 degree arthroscope through a standard posterolateral insertion site. Under direct visual with use of a spinal needle for localization , i created both an interior working portal at the superior border of the subscapularis as well as a high rotator interval prtal just posterior to the biceps tendon within a rotator interval. The camera was then placed in the high rotator interval portal in a similar fashion a cannula was placed posteriorly into the joint fllowed by a second more lateral portal for better angle on the glenoid. At this time diagnostic arthroscopy revealed evidence of a superior labrum anterior, posterior tear type 1 with a large flap that ws nearly frankly torn off of the rim itself. This was debrided with a shaver. The Bicipital anchor as well as the root did appear to be well affixed to the gleniod. Anterior inferiorly the labrum was completely detached from the glenoid face as well as posterioly extending from the 3 oclock position all the way down to the 6 oclock position and then up around anterior inferiorly to the glenoid. there was a large loose fragment that was flipped up between the humeral head and the glenoid inferiorly as well which was debrided with a shaver.The undersurface of the supraspinatus was visualized and found to have partial articular fraying and patial articular sided tear less than 4mm and this was simply debrided. The infraspinatusinsertion was normal as was the bare spot in the axillary recess. The cartilage on the humeral head and on the gleniod itself revealed normal articular cartilage with only some minor fraying and softening anteriorly and posteriorly at the very ellipse where the humeral head was subluxing out of the joint. At this time we passed a suture lasso underneath the posterior inferior labrum and placed 2 2.9mm PushLock anchors firmly reapproximating the posterior inferior labrum to the gleniod face after use of a Bankart rasp and shaver to stimulate bleeding and remove any soft tissue from the gleniod face. Next anteriorly we similarly placed 2 anchors anteriorly and inferiorly , 1 at the approxiamtely 3:30 position and 1 down around the 5 oclock position with the use of a suture lassoafter successfully repairing the labrum to the gleniod face. i used the bankart rasp to remove any soft tissue as well. I did take care to mobilize the anterior inferior labrum such that the supracapularis muscle could be visulaized underneath prior to fixation. At this time the shoulder was found to be centered within the eye gleniod rim.. At this time all instruments were removed from the joint.

Your thoughts?:rolleyes:
 

JMeggett

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When choosing between 29806 or 29807, think of slap tears on the face of a clock. Type I would be in the 1:00oclock position, Type II at 2:00, Type III at 3:00...and so on. When reading the operative note, surgeon's will often refer to working in the 3:00 - 6:00pm position...or wherever they're at. I've been taught that when they're referencing the work being done in the upper half of the clock face, to code it as 29807. The lower half would be 29806. Your surgeon here is clearly referencing the 3:00 - 6:00 portion, and I would choose 29806. He also mentions using a Bankart rasp, which also makes me think he's doing a 29806 which can also be called the Bankart procedure. CCI bundles 29822 in with 29806, so if the insurance you're billing uses CCI as their edit program then I wouldn't bill 29822.

Jenna
 
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