Wiki Arthroscopic Shoulder procedure - Need Help

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I do not code Ortho very ofter and this one is stumping me. Thank you for your help!

PREOPERATIVE DIAGNOSES: Left frozen shoulder, impingement syndrome, partial rotatorcuff tear.

POSTOPERATIVE DIAGNOSES: Left frozen shoulder, impingement syndrome, partialrotator cuff tear; biceps pathology; plus glenohumeral arthritis.

PROCEDURES: Diagnostic and operative arthroscopy of the left shoulder, arthroscopiccapsule release and lysis of adhesions, arthroscopic joint debridement and rotatorcuff tendon debridement, arthroscopic biceps tenotomy, arthroscopic subacromialdecompression including acromioplasty.

COMPLICATIONS: None.

DRAINS: One PainBuster.

PROCEDURE: After regional anesthesia been induced, the patient was placed on thetable in a beach-chair position. The left upper extremity and shoulder was preppedand draped in a sterile fashion. Examination under anesthesia, showed the patientlacked about 20% of her terminal motion arc in all directions. Standard anterior-posterior lateral portals were established. Diagnostic and operative arthroscopythen ensued. Intra-articular pathology found diffuse cartilage loss. I wouldestimate she has lost 50% of the articular cartilage throughout her joint. Therewas nothing really that needed to be debrided, though. Biceps tendon was extremelytenosynovitic and degenerative in appearance and a tenotomy was performed with thecautery. Superior labrum was debrided. Rotator cuff tendon had a 20% undersurfacetear that required debridement. This was done with a shaver. We then redirectedthe instruments in the subacromial space. A thorough arthroscopic subacromialdecompression including acromioplasty was performed with a shaver, bur and suctionablator. The patient had a moderate-sized acromial spur. Very dense and thickperihumeral adhesions present. At this point, I removed the arthroscopicinstruments from the joint and put a PainBuster in the subacromial space and Iclosed the portals with 3-0 nylon, I applied a sterile bulky dressing. There wereno operative complications.
 
Here are the 4 procedures: 29825-Lysis of adhesions, 29822-Debridement, 29828- Biceps Tenodesis and 29826- Sub. Acr. Decompression. 2 codes are bundled with others so you'll only be able to charge for 2 of the 4.

29828,LT- 726.12, 726.10 & 716.91
29826,51- 726.2, 726.0 & 716.91

29822 is bundled with 29828, both performed in the glenohumeral joint. 29825 is bundled with 29826, both performed in the subacromial joint, plus the note doesn't really go into enough detail for the lysis of adhesions. So you can't charge 29822 or 29825.

Your diagnosis should be:

726.0- Frozen Shoulder
726.2- Impingement Syndrome
726.10- Partial R.C. Tear/Fraying
726.12- Biceps Pathology
716.91- Arthritis

Hope that helps!!
 
I disagree

I dont see the 29828 in the above op note. 29828 is for a biceps TENODESIS. In this op note it appears to be a TENOTOMY that was performed in which there is no code for thus being a 29999.

29828
Arthroscopy, shoulder, surgical; biceps tenodesis

Lay Description

The physician performs arthroscopic biceps tenodesis. With the patient under appropriate anesthesia, standard arthroscopic portals are established. A monofilament suture is passed through an 18-gauge needle placed into the biceps tendon, and an arthroscopic suture instrument is utilized to retrieve the suture. The physician uses an arthroscopic basket to release the tendon from its origin, and the arthroscopic equipment is transferred to the subacromial space. Using the arthroscopic basket, the physician identifies and opens the tendon sheath. Electrocautery may be used to clean the surrounding tissues. A probe is utilized to free the tendon, which is extracted through one of the arthroscopic portals. The tendon is then pulled into a humeral socket that has been drilled at the top of the bicipital groove. Under arthroscopic control, it is fixed using a bioabsorbable interference screw. Instrumentation is removed and the arthroscopic portals are closed with sutures.

my opinion:
29826
29823 (both labrum and rc was debrided)
29999

Mary, CPC, CPC-ORTHO
 
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