Desperate Denise
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Here we go again with the shoulder ---
Can you should experts conform with me that both docs in both situations can bill 29826 and 29823 with modifier 59. I sometimes get confuse cuz the edits state I cannot bill 29823 with 29826 and the docs say that they can cuz the debridement (29823) was back and front. Do you guys feel that in both cases that 29823 is okay to bill to BLUE SHIELD and that the MODIFIER 59 is okay.
THANK YOU SOOOO MUCH !!!!! Denise
OPERATIVE REPORT #1
POSTOPERATIVE DIAGNOSIS:
1. Left shoulder rotator cuff tear.
2. Impingement syndrome.
3. Labral tear.
OPERATION PERFORMED:
1. Left shoulder arthroscopy,
2. Partial rotator cuff tear debridement, type 1 labral debridement 29823-59
3. Subacromial decompression. 29826
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room, placed supine on the operating table. After induction of general anesthetic and interscalene block, she was placed in the beach-chair position. All bony prominences were padded. Her left shoulder was prepped and draped in a standard surgical fashion. A posterior portal was created. Examination of the joints showed no glenohumeral articular surfaces. There was a 10% tear of the supraspinatus tendon which was debrided with a 35-mm fulgurated shaver. Biceps anchor showed type 1
labral tear and it was debrided with 35-mm fulgurated shaver.
Attention was directed to the subacromial space where the rotator cuff was intact from above. Subacromial decompression was carried out arthroscopically.
OPERATIVE REPORT #2
POSTOPERATIVE DIAGNOSIS:
1. Right shoulder pain.
2. Right shoulder posterior labral tear.
3. Right shoulder glenohumeral joint arthritis.
4. Right shoulder impingement.
OPERATION PERFORMED:
1. Right shoulder arthroscopy.
2. Right shoulder debridement. 29823-59
3. Right shoulder subacromial decompression. 29826
DESCRIPTION OF PROCEDURE: The patient was brought to the preoperative
area. The site and side were identified. Then an interscalene block was
administered. He was then brought in the operating room, placed supine on
the operating room table. Bony prominences were padded appropriately.
General endotracheal intubation was performed. He was then placed in the
beach chair position. Examination of the right shoulder under anesthesia
revealed full passive range of motion in all planes. The right upper
extremity was prepped and draped in a sterile fashion. Bony landmarks of
the shoulder including posterolateral, lateral and anterior lateral aspect
of the acromion, AC joint and coracoid process were marked with a marking
pen. Then a mark was made 2 fingerbreadths down, 2 fingerbreadths medial
from the posterolateral aspect of the acromion.
An 18 gauge spinal needle was inserted into the glenohumeral joint. The
joint was distended with 60 mL of sterile saline. An 11 blade scalpel was
used to incise the skin and the arthroscope was introduced in the
posterior aspect of the glenohumeral joint. There was evidence of a large
flap tear off the posterior labrum. This was interposed between the
glenoid and humeral surfaces. There was evidence of grade 2
chondromalacia changes over the humeral head. There was evidence of grade
2 chondromalacia changes over the glenoid surface, particularly over the
posterior inferior margin there was grade 3-4 changes. There was no
evidence of superior labral tear. The biceps tendon was in good
condition. The subscapularis muscle was in good condition. The
supraspinatus, infraspinatus and teres minor appeared intact with no
evidence of tearing or fraying. No evidence of loose bodies within the
axillary pouch.
An anterior portal was established using outside in technique. An 18
gauge spinal needle was inserted above the superior border of the
subscapularis muscle. An 11 blade scalpel was used to incise the skin. A
7-mm cannula was introduced in the glenohumeral joint. The posterior
labral flap was debrided. The labrum itself appeared to be well attached
to the superior and anterior aspect of the glenoid. The biceps tendon was
brought into the glenohumeral joint area. The rotator cuff and
subscapularis muscle were inspected in their entirety. A posterior
working portal was established and the camera was switched to the anterior
portion. The posterior labrum was viewed, it was felt to be more frayed
than detached and once again there was evidence of arthritic
chondromalacia over the posterior inferior glenoid surface. Once all
intra-articular work was complete, the arthroscope from the glenohumeral
joint and introduced in the subacromial space. There was evidence of
bursitis. A complete bursectomy was performed. The rotator cuff was
cleared of all soft tissue. The coracoacromial ligament was released.
The undersurface of the acromion was cleared of all soft tissue. Using a
4-0 acromionizer bur a subacromial decompression was performed. Once this
was complete, the arm was brought through internal and external rotation
and there was no evidence of bursal sided rotator cuff tearing. Once all
work was complete all arthroscopic instrumentation was removed from the
subacromial space.
Can you should experts conform with me that both docs in both situations can bill 29826 and 29823 with modifier 59. I sometimes get confuse cuz the edits state I cannot bill 29823 with 29826 and the docs say that they can cuz the debridement (29823) was back and front. Do you guys feel that in both cases that 29823 is okay to bill to BLUE SHIELD and that the MODIFIER 59 is okay.
THANK YOU SOOOO MUCH !!!!! Denise
OPERATIVE REPORT #1
POSTOPERATIVE DIAGNOSIS:
1. Left shoulder rotator cuff tear.
2. Impingement syndrome.
3. Labral tear.
OPERATION PERFORMED:
1. Left shoulder arthroscopy,
2. Partial rotator cuff tear debridement, type 1 labral debridement 29823-59
3. Subacromial decompression. 29826
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room, placed supine on the operating table. After induction of general anesthetic and interscalene block, she was placed in the beach-chair position. All bony prominences were padded. Her left shoulder was prepped and draped in a standard surgical fashion. A posterior portal was created. Examination of the joints showed no glenohumeral articular surfaces. There was a 10% tear of the supraspinatus tendon which was debrided with a 35-mm fulgurated shaver. Biceps anchor showed type 1
labral tear and it was debrided with 35-mm fulgurated shaver.
Attention was directed to the subacromial space where the rotator cuff was intact from above. Subacromial decompression was carried out arthroscopically.
OPERATIVE REPORT #2
POSTOPERATIVE DIAGNOSIS:
1. Right shoulder pain.
2. Right shoulder posterior labral tear.
3. Right shoulder glenohumeral joint arthritis.
4. Right shoulder impingement.
OPERATION PERFORMED:
1. Right shoulder arthroscopy.
2. Right shoulder debridement. 29823-59
3. Right shoulder subacromial decompression. 29826
DESCRIPTION OF PROCEDURE: The patient was brought to the preoperative
area. The site and side were identified. Then an interscalene block was
administered. He was then brought in the operating room, placed supine on
the operating room table. Bony prominences were padded appropriately.
General endotracheal intubation was performed. He was then placed in the
beach chair position. Examination of the right shoulder under anesthesia
revealed full passive range of motion in all planes. The right upper
extremity was prepped and draped in a sterile fashion. Bony landmarks of
the shoulder including posterolateral, lateral and anterior lateral aspect
of the acromion, AC joint and coracoid process were marked with a marking
pen. Then a mark was made 2 fingerbreadths down, 2 fingerbreadths medial
from the posterolateral aspect of the acromion.
An 18 gauge spinal needle was inserted into the glenohumeral joint. The
joint was distended with 60 mL of sterile saline. An 11 blade scalpel was
used to incise the skin and the arthroscope was introduced in the
posterior aspect of the glenohumeral joint. There was evidence of a large
flap tear off the posterior labrum. This was interposed between the
glenoid and humeral surfaces. There was evidence of grade 2
chondromalacia changes over the humeral head. There was evidence of grade
2 chondromalacia changes over the glenoid surface, particularly over the
posterior inferior margin there was grade 3-4 changes. There was no
evidence of superior labral tear. The biceps tendon was in good
condition. The subscapularis muscle was in good condition. The
supraspinatus, infraspinatus and teres minor appeared intact with no
evidence of tearing or fraying. No evidence of loose bodies within the
axillary pouch.
An anterior portal was established using outside in technique. An 18
gauge spinal needle was inserted above the superior border of the
subscapularis muscle. An 11 blade scalpel was used to incise the skin. A
7-mm cannula was introduced in the glenohumeral joint. The posterior
labral flap was debrided. The labrum itself appeared to be well attached
to the superior and anterior aspect of the glenoid. The biceps tendon was
brought into the glenohumeral joint area. The rotator cuff and
subscapularis muscle were inspected in their entirety. A posterior
working portal was established and the camera was switched to the anterior
portion. The posterior labrum was viewed, it was felt to be more frayed
than detached and once again there was evidence of arthritic
chondromalacia over the posterior inferior glenoid surface. Once all
intra-articular work was complete, the arthroscope from the glenohumeral
joint and introduced in the subacromial space. There was evidence of
bursitis. A complete bursectomy was performed. The rotator cuff was
cleared of all soft tissue. The coracoacromial ligament was released.
The undersurface of the acromion was cleared of all soft tissue. Using a
4-0 acromionizer bur a subacromial decompression was performed. Once this
was complete, the arm was brought through internal and external rotation
and there was no evidence of bursal sided rotator cuff tearing. Once all
work was complete all arthroscopic instrumentation was removed from the
subacromial space.
