jdibble
True Blue
Good Afternoon!
I have a provider who does Arthroscopic Rotator Cuff repairs with and without grafts. I have discussed with him that the graft is included in 29827 and not separately billed. He feels that the work he does when he applies the graft is above and beyond the work included in 29827 and the graft portion should be billed separately. I have been asked to review his documentation on 25 cases to compare and verify if the documentation supports more work than the standard CPT code. After reviewing all the notes, I concluded that aside from maybe a few changes, such as cm sizes and possibly the addition of a reason for adding a graft, all the notes are basically cut and paste. My question is, based on the documentation of the procedures below where a graft was used, would this warrant an additional charge. I have discussed using a 22 modifier with him, but he feels we should create an unlisted code for the graft portion. (not sure what code this would compare to!)
This is his standard RCR note without a graft:
Rotator Cuff Repair cpt 29827
There was a tear in the supraspinatus infraspinatus subscapularus tendons measuring 2cm lateral to medial and 3 cm from anterior to posterior. I performed a complete bursectomy to fully appreciate the extent of the tear. The greater tuberosity footprint was prepared to bleeding bone using a bone-cutting shaver. From the lateral portal, a grasper was used to assess tension on the tendon and determine the best placement of suture for a tension-free repair. A lateral canula was placed. Percutaneous incisions were created for 1 medial suture anchors. Suture was passed through the torn tendon after releasing the CHL, subacromial and intra-articular adhesions to the tendon. I then placed 2 anchor (s) lateral to the rotator cuff footprint. The sutures were tensioned and locked within the lateral anchor (s) to compress the tendon against the prepared rotator cuff footprint. The repair was tension free and was then visulalized through the lateral portal.
This is his note for the repair with a graft:
RCAUGMENTATION
Acellular Dermal Augmentation of the Rotator cuff cpt 29827
As there was no full-thickness can not component but high-grade partial-thickness tearing meeting Ellman's criteria and though demonstrative intra tendinous tendinopathy on MRI, I prepared an acellular dermal graft (Arthrex) which was cut to the size of the measured defect. The acellular dermal matrix was then sutured using the luggage tag and medial suture anchor sutures. I created a second lateral portal. The cuffmend system was used to introduce the graft through a large lateral canula. Knotless fiberstitch anchors were placed medially through a 5x7mm canula. Laterally, the graft was secured using SwiveLock anchors with sutures placed laterally in the graft as well as crossing sutures that compressed the graft to the repaired native rotator cuff tendon.
This is his note when he documents both the standard RCR and then the graft separately and wants it coded separately (not sure if he is trying to say this was more work??):
RCREP
Rotator Cuff Repair cpt 29827
There was a tear in the supraspinatus tendons(s) measuring 3cm lateral to medial and 2 cm from anterior to posterior. I performed a complete bursectomy to fully appreciate the extent of the tear. The greater tuberosity footprint was prepared to bleeding bone using a bone-cutting shaver. From the lateral portal, a grasper was used to assess tension on the tendon and determine the best placement of suture for a tension-free repair. Lateral cannulas were placed. 2 Margin convergance, 2 luggage tag sutures of #2 Fiberwire were placed. Suture was passed through the torn tendon after releasing the CHL, subacromial and intra-articular adhesions to the tendon. I then placed 1 anchor (s) lateral to the rotator cuff footprint. The sutures were tensioned and locked within the lateral anchor (s) to compress the tendon against the prepared rotator cuff footprint. The repair was tension free and was then visulalized through the lateral portal.
RCAUGMENTATION
Acellular Dermal Augmentation of the Rotator cuff cpt 29999 (equivalent to 29827)
I prepared an acellular dermal graft (Arthrex) which was cut to the size of the measured defect. The acellular dermal matrix was then sutured using the luggage tag and medial suture anchor sutures. I created a second lateral portal. The cuffmend system was used to introduce the graft through a large lateral canula. Knotless fiberstitch anchors were placed medially through a percutaneous incision. Laterally, the graft was secured using SwiveLock anchors with sutures placed laterally in the graft as well as crossing sutures that compressed the graft to the repaired native rotator cuff tendon.
I appreciate all of your opinions on this so that I can go back to him with a valid response.
Thanks,
Jodi
I have a provider who does Arthroscopic Rotator Cuff repairs with and without grafts. I have discussed with him that the graft is included in 29827 and not separately billed. He feels that the work he does when he applies the graft is above and beyond the work included in 29827 and the graft portion should be billed separately. I have been asked to review his documentation on 25 cases to compare and verify if the documentation supports more work than the standard CPT code. After reviewing all the notes, I concluded that aside from maybe a few changes, such as cm sizes and possibly the addition of a reason for adding a graft, all the notes are basically cut and paste. My question is, based on the documentation of the procedures below where a graft was used, would this warrant an additional charge. I have discussed using a 22 modifier with him, but he feels we should create an unlisted code for the graft portion. (not sure what code this would compare to!)
This is his standard RCR note without a graft:
Rotator Cuff Repair cpt 29827
There was a tear in the supraspinatus infraspinatus subscapularus tendons measuring 2cm lateral to medial and 3 cm from anterior to posterior. I performed a complete bursectomy to fully appreciate the extent of the tear. The greater tuberosity footprint was prepared to bleeding bone using a bone-cutting shaver. From the lateral portal, a grasper was used to assess tension on the tendon and determine the best placement of suture for a tension-free repair. A lateral canula was placed. Percutaneous incisions were created for 1 medial suture anchors. Suture was passed through the torn tendon after releasing the CHL, subacromial and intra-articular adhesions to the tendon. I then placed 2 anchor (s) lateral to the rotator cuff footprint. The sutures were tensioned and locked within the lateral anchor (s) to compress the tendon against the prepared rotator cuff footprint. The repair was tension free and was then visulalized through the lateral portal.
This is his note for the repair with a graft:
RCAUGMENTATION
Acellular Dermal Augmentation of the Rotator cuff cpt 29827
As there was no full-thickness can not component but high-grade partial-thickness tearing meeting Ellman's criteria and though demonstrative intra tendinous tendinopathy on MRI, I prepared an acellular dermal graft (Arthrex) which was cut to the size of the measured defect. The acellular dermal matrix was then sutured using the luggage tag and medial suture anchor sutures. I created a second lateral portal. The cuffmend system was used to introduce the graft through a large lateral canula. Knotless fiberstitch anchors were placed medially through a 5x7mm canula. Laterally, the graft was secured using SwiveLock anchors with sutures placed laterally in the graft as well as crossing sutures that compressed the graft to the repaired native rotator cuff tendon.
This is his note when he documents both the standard RCR and then the graft separately and wants it coded separately (not sure if he is trying to say this was more work??):
RCREP
Rotator Cuff Repair cpt 29827
There was a tear in the supraspinatus tendons(s) measuring 3cm lateral to medial and 2 cm from anterior to posterior. I performed a complete bursectomy to fully appreciate the extent of the tear. The greater tuberosity footprint was prepared to bleeding bone using a bone-cutting shaver. From the lateral portal, a grasper was used to assess tension on the tendon and determine the best placement of suture for a tension-free repair. Lateral cannulas were placed. 2 Margin convergance, 2 luggage tag sutures of #2 Fiberwire were placed. Suture was passed through the torn tendon after releasing the CHL, subacromial and intra-articular adhesions to the tendon. I then placed 1 anchor (s) lateral to the rotator cuff footprint. The sutures were tensioned and locked within the lateral anchor (s) to compress the tendon against the prepared rotator cuff footprint. The repair was tension free and was then visulalized through the lateral portal.
RCAUGMENTATION
Acellular Dermal Augmentation of the Rotator cuff cpt 29999 (equivalent to 29827)
I prepared an acellular dermal graft (Arthrex) which was cut to the size of the measured defect. The acellular dermal matrix was then sutured using the luggage tag and medial suture anchor sutures. I created a second lateral portal. The cuffmend system was used to introduce the graft through a large lateral canula. Knotless fiberstitch anchors were placed medially through a percutaneous incision. Laterally, the graft was secured using SwiveLock anchors with sutures placed laterally in the graft as well as crossing sutures that compressed the graft to the repaired native rotator cuff tendon.
I appreciate all of your opinions on this so that I can go back to him with a valid response.
Thanks,
Jodi