ASCR and Rotator Cuff Repair

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8
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Bartlett, IL
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If a provider performs an arthroscopic superior capsule reconstruction AND repairs the infraspinatus, are you able to bill both?

We normally bill 29999 for the ASCR but are unsure on whether or not you can bill 29827 for the infraspinatus repair in addition to it.
 

Orthocoderpgu

True Blue
Local Chapter Officer
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912
Location
Salt Lake City, UT
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I'm going to say yes. 29827 of the infraspinatus is a REPAIR. The ASCR is a RECONSTRUCTION. If your coding shoulder surgeries you really need to be familiar with our monthly trade magazine March 2016, July 2017 and the 2017 CMS NCCI Surgical Policy Manual.
 
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8
Location
Bartlett, IL
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I understand the difference between the repair and the reconstruction. The question was arising because you can only report 29827 once, regardless of how many of the rotator cuff tendons are repaired. Since the ASCR is done to reconstruct an irreparable rotator cuff tear, the same logic was being used.

The July 2017 article from the AAPC magazine only states to use 29999 for reporting the ASCR and that using 29806 or 29827 would be inappropriate. It does not specify whether repairs of the other rotator cuff tendons could also be reported.

If it is in fact appropriate to bill both, that's great. I am having trouble finding documentation for appealing this so was questioning it.
 

Orthocoderpgu

True Blue
Local Chapter Officer
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912
Location
Salt Lake City, UT
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I follow what your saying and why. If it were two repairs, then yes I would agree with the logic. But these are not two repairs, one is a reconstruction procedure and the reconstruction in no way replaces the supraspinatus. The graft has no function other than to help hold the shoulder joint in position. It provides no functionality. The purpose of a rotator cuff repair (which restores function) is entirely different than a ASCR. So I personally would not lump them together. I don't think your going to find any documentation which answers this specific question. But the "mission" as one of my surgeons calls it, or purpose is completely different. So I would say both should be allowed.
 
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