Arthroscopic shoulder surgery

Mauroj1

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Hi. Please advise on coding for the below Op Report, including any bundles on the shoulder procedures. Thank you.

PROCEDURE PERFORMED: Left shoulder arthroscopy with:
1. Rotator cuff repair - 29827
2. Bankart repair/Capsulorrhaphy - 29806
3. SLAP tear repair - 29807
4. Arthroscopic distal clavicle excision - 29824
5. Arthroscopic subacromial decompression - 29826

POSTOPERATIVE DIAGNOSIS: Left shoulder labral tear and rotator cuff tear and acromioclavicular joint arthropathy.

DESCRIPTION OF PROCEDURE: Standard posterior and anterior arthroscopic portals were created and inventory was taken of the glenohumeral joint. Cartilage on the humeral head and glenoid demonstrated grade II chondromalacia with no focal chondral defects. The labrum was examined and essentially was detached from the 7 o'clock position towards the 12 o'clock position. There was a normal Bufford complex noted as well. I felt that this labral tear was significant in that anterior inferiorly there was a piece of bone sitting within the labrum and capsule itself indicating to me a Bankart injury. This certainly could be contributing to some of her pain and mechanical symptoms. I felt that a repair would be necessary repairing both anterior inferior as well as the superior labrum. Her biceps tendon had previously ruptured. I prepared the edge of the glenoid appropriately and used a Linvatec MVP suture shuttling device to pass Arthrex labral tape around the labrum and capsule. I used an Arthrex PushLock anchor to repair the anterior inferior labrum. More superiorly, there was a normal Bufford complex. I did not repair this, but farther superiorly, there was a SLAP tear that I similary used an Arthrex labral PushLock to repair the labrum down the edge of the glenoid after preparing the tuberosity appropriately. Once all of this was completed, I identified the rotator cuff tear and placed the scope in the subacromial space. I completed a subacromial and subdeltoid bursectomy, found there to be an os acromiale noted and I used an RF device to outline the lateral and anterior edges of the acromion. Acromioplasty of appropriate degree was performed, the distal clavicle was identified and a distal clavicle excision measuring 8 mm was performed as well. I examined the rotator cuff and found this to be a crescent-shaped tear that was approximately 1 cm in AP dimension with 1 cm of retraction. I prepared the tuberosity appropriately then placed 2 Arthrex SwiveLock anchors loaded with FiberTape as medial rows I passed these sutures in individual manner through the rotator cuff. I took alternating strands of suture and placed them into 2 lateral row anchors, which were SwiveLocks as well. This created good compression across the prepared tuberosity and footprint of the rotator cuff. I found the rotator cuff to move in unison with the rest of the arm with no abnormal dog earring thoroughly irrigated the subacromial space and withdrew the scope. I closed the portal sites with 3-0 Prolene and Steri-Strips. She was dressed in the usual sterile fashion, placed into an abduction sling, extubated and brought to recovery room in stable condition.
 

Orthocoderpgu

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The coding of this is going to entirely depend on the payer. Payers that follow CMS, you would only be able to bill 29827, 29824, 29826. However, if they don't you may be able to bill out 29806 or 29807 as well. But this depends on the payer.
 
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