ortho1991
Guru
I hope someone can help not sure of how to bill these procedures.
arthroscopic procedure not sure how to bill this, and help or suggestions will be appreicated.
Here is the op-note in short.
RIGHT HIP DIAGNOSTIC ARTHROSCOPY, TROCHANTERIC BURSECTOMY, ABDUCTOR TENDON
REPAIR AND ILIOTIBIAL BAND LENGTHENING: With the hip not in traction, using
fluoroscopic imaging as a guide, an anterolateral portal was established under
guidewire technique. The trochanteric space was entered. There was moderate
bursitis and inflammation in the trochanteric space. A mid anterior portal
was established under direct visualization using a guidewire technique. Using
an arthroscopic shaver and a radiofrequency ablation device, an extensive
bursectomy was performed all the way proximally, distally, posteriorly and
anteriorly. At this point, once cleaning the entire bursa distal to the
gluteus maximus tendon, I could visualize the entire trochanteric space.
There was bruising and ecchymosis of the abductor tendons attached to the
greater trochanter. At the first glance, the tendons appeared to be intact,
but probing the tendons, they had no attachments beneath. There seemed to be
a high-grade undersurface tear. Using a Beaver blade, a longitudinal incision
in the tendons was performed. There was a clear tear underneath the abductor
tendons noted that had extended all the way proximally and distally. Using an
arthroscopic shaver, the abductor tendons were debrided and the footprint of
the tendons was debrided such that a good bleeding bony bed was identified.
The tendon was probed and _____ was able to pull and be brought over to the
footprint well. A third arthroscopic portal was then established, just
distally, a distal anterolateral portal was established. A percutaneous
portal was established and an anchor was placed in the center of the
footprint. A 5.5 mm _____ anchor was used. An excellent
purchase was obtained. We then used a 90-degree SutureLasso to pass sutures
through the abductor tendons proximally and distally. An excellent repair was
obtained. The sutures were tied with a combination of sliding and half hitch
sutures. Excellent repair of the tendon was noted. Once the tendon was
repaired that tendon was probed and was firmly reattached back to the
footprint. Copious irrigation was performed. Having performed the bursectomy
and abductor tendon repair, we focused our attention on the IT band. I did
not want to make a large window through the IT band and therefore just did a
gentle release of the gluteus maximus attachment at the IT band, thus creating
less tension and affect the lengthening of the IT band. Copious irrigation
was once again performed. All the bursa had been excised as extensively as
possible. The abductor tendon had been repaired and the IT band tension was
decreased. The patient had tolerated the procedure well. All the
arthroscopic equipment was removed. The 3 arthroscopy portals were closed
with 2-0 Vicryl in a deep fashion, 3-0 Monocryl in a subcuticular fashion and
Mastisol, Steri-Strips, Xeroform, and dry sterile dressings were applied. The
patient was awakened, taken to recovery room. She was wiggling her toes, had
brisk capillary refill.
Would it be appropriate to bill 29863 for the bursectomy and then 29999 for the ITband lengthening????
arthroscopic procedure not sure how to bill this, and help or suggestions will be appreicated.
Here is the op-note in short.
RIGHT HIP DIAGNOSTIC ARTHROSCOPY, TROCHANTERIC BURSECTOMY, ABDUCTOR TENDON
REPAIR AND ILIOTIBIAL BAND LENGTHENING: With the hip not in traction, using
fluoroscopic imaging as a guide, an anterolateral portal was established under
guidewire technique. The trochanteric space was entered. There was moderate
bursitis and inflammation in the trochanteric space. A mid anterior portal
was established under direct visualization using a guidewire technique. Using
an arthroscopic shaver and a radiofrequency ablation device, an extensive
bursectomy was performed all the way proximally, distally, posteriorly and
anteriorly. At this point, once cleaning the entire bursa distal to the
gluteus maximus tendon, I could visualize the entire trochanteric space.
There was bruising and ecchymosis of the abductor tendons attached to the
greater trochanter. At the first glance, the tendons appeared to be intact,
but probing the tendons, they had no attachments beneath. There seemed to be
a high-grade undersurface tear. Using a Beaver blade, a longitudinal incision
in the tendons was performed. There was a clear tear underneath the abductor
tendons noted that had extended all the way proximally and distally. Using an
arthroscopic shaver, the abductor tendons were debrided and the footprint of
the tendons was debrided such that a good bleeding bony bed was identified.
The tendon was probed and _____ was able to pull and be brought over to the
footprint well. A third arthroscopic portal was then established, just
distally, a distal anterolateral portal was established. A percutaneous
portal was established and an anchor was placed in the center of the
footprint. A 5.5 mm _____ anchor was used. An excellent
purchase was obtained. We then used a 90-degree SutureLasso to pass sutures
through the abductor tendons proximally and distally. An excellent repair was
obtained. The sutures were tied with a combination of sliding and half hitch
sutures. Excellent repair of the tendon was noted. Once the tendon was
repaired that tendon was probed and was firmly reattached back to the
footprint. Copious irrigation was performed. Having performed the bursectomy
and abductor tendon repair, we focused our attention on the IT band. I did
not want to make a large window through the IT band and therefore just did a
gentle release of the gluteus maximus attachment at the IT band, thus creating
less tension and affect the lengthening of the IT band. Copious irrigation
was once again performed. All the bursa had been excised as extensively as
possible. The abductor tendon had been repaired and the IT band tension was
decreased. The patient had tolerated the procedure well. All the
arthroscopic equipment was removed. The 3 arthroscopy portals were closed
with 2-0 Vicryl in a deep fashion, 3-0 Monocryl in a subcuticular fashion and
Mastisol, Steri-Strips, Xeroform, and dry sterile dressings were applied. The
patient was awakened, taken to recovery room. She was wiggling her toes, had
brisk capillary refill.
Would it be appropriate to bill 29863 for the bursectomy and then 29999 for the ITband lengthening????