Wiki Arthroscopic capsular release of shoulder

[klienhart]

Hi, need help with an arthroscopic capsular release of the shoulder. Would this be coded with 29822/29823?

 

[amyjph]

It depends on what was done during the case. If they have adhesive capsulitis or a contracture it's usually 29825. If there is other stuff going on and debridement is also done then you would start looking at the debridement codes. It really depends on the documentation in the op report.

 

[klienhart]

This is the op note -


Pre-Op Diagnosis Codes:
* Adhesive capsulitis of right shoulder [M75.01]

Post-Op Diagnosis: Same

Procedure(s):
RIGHT SHOULDER ARTHROSCOPY; CAPSULAR RELEASE WITH MANIPULATION-INTERSCALENE BLOCK

Surgeon(s):
Brian Chilelli, MD

Assistant:
Surgical Assistant: Leeanne Harper

Anesthesia: General

Estimated Blood Loss (mL): Minimal

Complications: None

Specimens:
* No specimens in log *

Implants:
* No implants in log *

Drains: * No LDAs found *

Findings: per dictation


Detailed Description of Procedure:
The patient was met in the preoperative holding area. Informed consent was obtained. Interscalene block was placed by anesthesia. She was taken back to the operative room and transferred to the table. General anesthesia was performed. He was placed in the beachchair position. All bony prominences were well-padded. Bilateral SCDs were placed. Upper extremity did demonstrate significant decreased passive motion. There was only about 80 degrees of forward flexion and abduction with about 20-30 degrees of external rotation. Upper extremity was prepped and draped using standard sterile technique. Formal timeout was performed in which the correct patient, surgical site, and procedure was reaffirmed. Preventive antibiotics were given within 30 minutes of skin incision.

Initial incision was made just inferior medial to the posterior lateral border of the acromion. Trocar was introduced into the glenohumeral joint. Arthroscope was introduced. Diagnostic arthroscopy was performed. Anterior portal was created via an outside in technique. The subscapularis was intact. Glenoid was intact without evidence of chondral abnormality. There was no abnormality of the humeral head chondral surface. There are some fraying of the anterior labrum but no discrete tear. There is significant adhesions in scarring within the rotator cuff interval. Overall the rotator cuff repair appear to be intact. There is significant erythema within the joint itself. At that point we proceeded with capsular release. We used a radiofrequency wand to release the anterior interval tissue as well as the tissue anterior to the subscapularis down to the inferior capsule. Arthroscopic shaver was also utilized to debride interval tissue. Following this we did switch her camera to the anterior portal. We did perform a posterior capsular release using a radiofrequency wand. I'm leaning towards 29825, but would like another opinion.

At that point the arthroscope was taken to the subacromial space. A lateral working portal was created. There was significant bursal tissue and adhesions within the subacromial space. Therefore a thorough subacromial bursectomy was performed with lysis of adhesions within the subacromial space. The entire bursal surface of the rotator cuff was completely healed. Following our lysis of adhesions and bursectomy we did remove arthroscopic instruments and performed a gentle manipulation under anesthesia. Following this we were able to achieve about 130 to 140 degrees of forward flexion and abduction with approximately 40 to 50 degrees of external rotation.

Portal sites were closed using 3-0 nylon in interrupted fashion. Sterile dressings were applied in the form of Xeroform, 4 x 4's, ABD, and foam tape. She was placed into a standard sling. Then the procedure all counts were correct and I was present for entire case. Postoperatively the sling will be for comfort only. She was instructed to come out of it and start using range of motion immediately once the block wears off. He will start physical therapy tomorrow with aggressive range of motion exercises. Return to see me in office of the neck scheduled visit.

 

[Orthocoderpgu]

Hi, need help with an arthroscopic capsular release of the shoulder. Would this be coded with 29822/29823?

Heads up, always include a diagnosis when asking about an orthopedic procedure. As you can see, just knowing what was performed is not enough. As Amy has pointed out the capsular release could be reported as/with 29822, 29823, 29825 and others as well. The diagnosis and other procedures performed must always be considered as well.

 

[amyjph]

I agree with you wanting to report 29825. The intent was release with manipulation due to adhesive capsulitis (frozen shoulder). Even though there was some debridement and bursectomy performed it was "incidental" in my opinion. Further, 29822 has an edit w/ 29825.

Looks like the patient had a RCR prior and for whatever reason (usually they don't do their home exercise program in PT or are struggling with pain/issues and can't participate in PT enough) got a frozen shoulder following.