cmasters
Contributor
Hello! I am new to orthopedics coding, and my provider billed these 29806 29807 and 29827. Can anyone help me if this is correct based on the following documentation?
The right upper extremity was then prepped and draped in a typical sterile fashion. A preoperative timeout was taken after preoperative MrRI study was reviewed. The examination under anesthesia demonstrated glenohumeral shifting of the anterior and anterior-inferior planes, but no direct inferior or posterior instability was present. A posterior portal was then established and a 30- degree arthroscope was introduced atraumatically into the glenohumeral joint space. A complete diagnostic arthroscopy was performed. This demonstrated relatively well preserved articular surfaces of the glenoid and humerus with slight degenerative changes. Complete absence of the entire anterior labrum and labra ligamentous complex appeared to be healed along the more medial aspect of the scapula. A small amount of glenoid bone loss was noted anteriorly. There was no evidence of an inverted pear appearance to the glenoid, however a shallow hill-sachs lesion was also noted posteriorly. Inspection of the biceps demonstrated intact tendon throughout intraarticular line but again a superior labral tear was note superiorly. The more posterior labrum was intact. The articular supraspinatus and infraspinatus tendons were intact as was the subscapularis. A separate anterior portal was established and a 4.0 mm shaver was introduced. Mobilization of the entire anterior labrum and labrum ligamentous complex was undertaken with both mechanical shavers and periosteal elevator. Once adequate mobilization was obtained, the glenoid rim was gently debrided in preparation for repair. Anterior cannulas were then established. Using Athrex all suture anchor the anchor was initially placed close to the 5 o clock position. Multiple anchors were then placed, beginning from inferior to superior. Arthrex suture shuttle was then used to capture the inferior glenohumeral ligament complex and capsule in addition to the labrum. The anchor was then placed and the repair suture was then passed. The suture was then retrieved through the separate superior cannula and then placed into the shuttle mechanism and the repair suture was then locked into place, while gently lifting or elevating the capsule and adjacent labral structures in appropriated position. Again this process was repeated multiple times. Anchors were then place along this adjacent to the superior labrum. Using angled penetrating suture grasper, sutures were retrieved through a separate cannula. These were then placed through another self locking anchor, which was then used to repair the superior labrum in place. The final construct was carefully assessed from inferior to superior. A substantial improvement in appearence was obtained with a bumper appearance along the anterior glenoid. The arthroscope was then switched to the anterior portal and the posterior hill-sachs lesion was then identified. Using the posterior cannula 2.9mm self locking screw and anchors were then placed after preparation of the defect. The cannula was backed out and then using angled penetrating suture graspers, we used to retrieve the repair suture from one anchor and placed into the shuttle mechanism of the other anchor. This process was completed again until the defect was filled with the infraspinatus and the repair of the rotator cuff tendon was firmly anchored. The instruments were then withdrawn and the portal sites were re-approximated.
Thank you
The right upper extremity was then prepped and draped in a typical sterile fashion. A preoperative timeout was taken after preoperative MrRI study was reviewed. The examination under anesthesia demonstrated glenohumeral shifting of the anterior and anterior-inferior planes, but no direct inferior or posterior instability was present. A posterior portal was then established and a 30- degree arthroscope was introduced atraumatically into the glenohumeral joint space. A complete diagnostic arthroscopy was performed. This demonstrated relatively well preserved articular surfaces of the glenoid and humerus with slight degenerative changes. Complete absence of the entire anterior labrum and labra ligamentous complex appeared to be healed along the more medial aspect of the scapula. A small amount of glenoid bone loss was noted anteriorly. There was no evidence of an inverted pear appearance to the glenoid, however a shallow hill-sachs lesion was also noted posteriorly. Inspection of the biceps demonstrated intact tendon throughout intraarticular line but again a superior labral tear was note superiorly. The more posterior labrum was intact. The articular supraspinatus and infraspinatus tendons were intact as was the subscapularis. A separate anterior portal was established and a 4.0 mm shaver was introduced. Mobilization of the entire anterior labrum and labrum ligamentous complex was undertaken with both mechanical shavers and periosteal elevator. Once adequate mobilization was obtained, the glenoid rim was gently debrided in preparation for repair. Anterior cannulas were then established. Using Athrex all suture anchor the anchor was initially placed close to the 5 o clock position. Multiple anchors were then placed, beginning from inferior to superior. Arthrex suture shuttle was then used to capture the inferior glenohumeral ligament complex and capsule in addition to the labrum. The anchor was then placed and the repair suture was then passed. The suture was then retrieved through the separate superior cannula and then placed into the shuttle mechanism and the repair suture was then locked into place, while gently lifting or elevating the capsule and adjacent labral structures in appropriated position. Again this process was repeated multiple times. Anchors were then place along this adjacent to the superior labrum. Using angled penetrating suture grasper, sutures were retrieved through a separate cannula. These were then placed through another self locking anchor, which was then used to repair the superior labrum in place. The final construct was carefully assessed from inferior to superior. A substantial improvement in appearence was obtained with a bumper appearance along the anterior glenoid. The arthroscope was then switched to the anterior portal and the posterior hill-sachs lesion was then identified. Using the posterior cannula 2.9mm self locking screw and anchors were then placed after preparation of the defect. The cannula was backed out and then using angled penetrating suture graspers, we used to retrieve the repair suture from one anchor and placed into the shuttle mechanism of the other anchor. This process was completed again until the defect was filled with the infraspinatus and the repair of the rotator cuff tendon was firmly anchored. The instruments were then withdrawn and the portal sites were re-approximated.
Thank you