Wiki Multiple shoulder procedures - Help--shoulder surgeries are so confusing

[kathymarks]

Help--shoulder surgeries are so confusing. I work for a payer and I have a physician billing for an arthroscopy of the shoulder. He started with diagnostic arthroscopy, then proceeded to debriding the long head of the biceps tendon. Then he moved the arthroscope to the subacromial space and did a subtotal bursectomy and released the coracoacromial ligament off the anterior aspect of the acromion (but did not resect it). Then he resected 8 mm of distal clavicle. He also repaired the linear rent in the bursal surface of the rotator cuff. The lateral tuberosity was microfractured to stimulate a healing response. A mechanized bur abraded the denuded portion of the lesser tuberosity and an anchor was tapped into place 7 mm off the articular surface. Sutures were passed through the torn retracted portion of the subscapularis and tied down. Bony debris was removed from the subacromial space. The physician billed 29827-rotator cuff repair; 29826-decompression of subacromial space; 29824-distal claviculectomy; 29822-limited debridement; and 29999-arthroscopic repair of subscapularis. Are all of these appropriate for payment or are some bundled with the other procedures. Thanks a lot for any help.

 

[Bella Cullen]

Help--shoulder surgeries are so confusing. I work for a payer and I have a physician billing for an arthroscopy of the shoulder. He started with diagnostic arthroscopy, then proceeded to debriding the long head of the biceps tendon. Then he moved the arthroscope to the subacromial space and did a subtotal bursectomy and released the coracoacromial ligament off the anterior aspect of the acromion (but did not resect it). Then he resected 8 mm of distal clavicle. He also repaired the linear rent in the bursal surface of the rotator cuff. The lateral tuberosity was microfractured to stimulate a healing response. A mechanized bur abraded the denuded portion of the lesser tuberosity and an anchor was tapped into place 7 mm off the articular surface. Sutures were passed through the torn retracted portion of the subscapularis and tied down. Bony debris was removed from the subacromial space. The physician billed 29827-rotator cuff repair; 29826-decompression of subacromial space; 29824-distal claviculectomy; 29822-limited debridement; and 29999-arthroscopic repair of subscapularis. Are all of these appropriate for payment or are some bundled with the other procedures. Thanks a lot for any help.

The only one I would not bill is 29999 because I feel that is bundled with 29827.
I would code these:
29827, 29826, 29824, 29822-59.

 

[kathymarks]

Multiple shoulder procedures

Thanks Bella. To help myself in understanding, since the rotator cuff is comprised of four muscles--supraspinatus, infraspinatus, subscapularis and teres minor--any repair to any of those muscles would be included in a rotator cuff repair. Is my thinking correct or am I being too general. Just trying to get a handle on this. Thanks,

 

[Bella Cullen]

Thanks Bella. To help myself in understanding, since the rotator cuff is comprised of four muscles--supraspinatus, infraspinatus, subscapularis and teres minor--any repair to any of those muscles would be included in a rotator cuff repair. Is my thinking correct or am I being too general. Just trying to get a handle on this. Thanks,

Yes, that is my understanding as well. So I believe your thinking is correct.