I'd appreciate suggestions coding the above procedure. The other surgical coders and myself thought applying a 22 modifier would be sufficient, but the surgeon seems to think we should be able to bill another code for it. He has asked about tendon transfer. (The biceps tendon is not diseased) There is no arthroscopic biceps tendon transfer code, so it would have to be unlisted (29999). Comparing to the open tendon transfer code (23395) seems too much. We coders feel comparing to arthroscopic biceps tenodesis (29828) is more appropriate. Your thoughts?
Here is the body of the procedure:
After prepping and draping the shoulder, a standard posterior portal was placed and a diagnostic arthroscopy was performed. The glenoid cartilage was intact. The humeral head cartilage was intact. The biceps tendon was intact. The labrum was intact. The visualized articular portion of the rotator cuff was not intact. The subscapularis was intact. An extensive intra articular debridement was not performed. After the intra articular part was completed, the camera was placed into the subacromial space and a lateral portal was established using a spinal needle as a guide. I placed the camera from the side and from the back, through a 7 mm screw-in cannula, I did a thorough subacromial bursectomy. Extensive bursitis was present. An acromioplasty was unnecessary. I identified the tear in the supraspinatus tendon-it was scarred and retracted to the level of the glenoid. I did an anterior interval slide and freed the tendon. I placed an anchor at the anterior articular margin and transferred the proximal biceps tendon to span the anterior portion of joint. The biceps tendon was secured I established an accessory portals using a spinal needle as guide. Through 7 mm smooth cannula(s), I thoroughly debrided from the footprint to the articular margin. I slightly decorticated the bone as well with a burr in reverse. I percutaneously placed 1 anchor(s) at the articular margin. The anchor(s) was/were placed with good fixation. The sutures were passed back to front in a horizontal mattress fashion using a suture passer. The knots were tied using an arthroscopic sliding knot tying technique. We did a single row repair. Afterwards, the arthroscopy was terminated, and the wounds were closed. Bulky dressing was applied and an abduction sling was placed. The patient was brought to the recovery room in good condition.
Thanks again for your input!
Here is the body of the procedure:
After prepping and draping the shoulder, a standard posterior portal was placed and a diagnostic arthroscopy was performed. The glenoid cartilage was intact. The humeral head cartilage was intact. The biceps tendon was intact. The labrum was intact. The visualized articular portion of the rotator cuff was not intact. The subscapularis was intact. An extensive intra articular debridement was not performed. After the intra articular part was completed, the camera was placed into the subacromial space and a lateral portal was established using a spinal needle as a guide. I placed the camera from the side and from the back, through a 7 mm screw-in cannula, I did a thorough subacromial bursectomy. Extensive bursitis was present. An acromioplasty was unnecessary. I identified the tear in the supraspinatus tendon-it was scarred and retracted to the level of the glenoid. I did an anterior interval slide and freed the tendon. I placed an anchor at the anterior articular margin and transferred the proximal biceps tendon to span the anterior portion of joint. The biceps tendon was secured I established an accessory portals using a spinal needle as guide. Through 7 mm smooth cannula(s), I thoroughly debrided from the footprint to the articular margin. I slightly decorticated the bone as well with a burr in reverse. I percutaneously placed 1 anchor(s) at the articular margin. The anchor(s) was/were placed with good fixation. The sutures were passed back to front in a horizontal mattress fashion using a suture passer. The knots were tied using an arthroscopic sliding knot tying technique. We did a single row repair. Afterwards, the arthroscopy was terminated, and the wounds were closed. Bulky dressing was applied and an abduction sling was placed. The patient was brought to the recovery room in good condition.
Thanks again for your input!