Anna Weaver
Guest
I have a physician who would like to code 29805, 23412, 23130.
I am having a time with this one. Would like opinions please.
The patient was put in the supine position under general anesthesia and then he was turned over in a lateral decubitus. After preparation and drapement on the left arm, while it was hanging in traction with a posterior approach, the arthroscope was inserted and inflow and outflow was established.
The synovial membrane was normal. He has some glenohumeral degenerative joint disease. In some areas even you could see the subchondral bone. Glenoid labrum was intact circumferentially. There was no evidence of biceps degeneration or tear that I could see. At this time, the rotator cuff was inspected and the retracted chronic tear was identified. This was large enough to warrant minimally open repair.
At this time the scope was removed and the patient was re-prepped and re-draped using a beach chair position. Following that through an anterior approach an incisiion was made and was taken down through the subcutaneous tissue using a muscle splitting approach between the medial and lateral head of the deltoid. The approach was made towards the subacromial space. The coracoacromial ligament was excised and the anterior edge of the acromion was exposed. At this time decompression acromioplasty and resection of the anterior edge of the acromioin was exposed. At this time decompression acriomioplasty and resection of the osteophytes underneath the AC joint was done. A bursectomy was carried out. Full thickness rotator cuff tear with almost about a centimeter and a half retraction was noted. The edges were freshened up. The foot plate of the rotator cuff on the greater tuberosity was prepared. At this time using absorbable screw anchor sutures were used for a second row repair of the rotator cuff. AT the end fixation was excellent. The shoulder was taken to a full range of motion with no evidence of impingement and the repair was excellent. Irrigation and primary closure and dressing was applied. An arm sling was applied. The patient tolerated the procedure well and left the operating room in a stable condition. There were no complications through this procedure.
Now, do you think he should be able to charge all 3 codes? I have fought this before and lost, I code this surgery (with the understanding that it may or may not pay) 23412, 23130-59. Now he wants to add in the 29805 diagnostic arthroscopy. I am on the fence with this one. I see where he thinks it should, but everything I have read indicates that if the surgery turns into an open procedure, that's what you code.
Any opinions out there? Please? All are welcome! I need some discussion on this so I know where I'm going! whether I'm on the right track, or not. Thanks!
I am having a time with this one. Would like opinions please.
The patient was put in the supine position under general anesthesia and then he was turned over in a lateral decubitus. After preparation and drapement on the left arm, while it was hanging in traction with a posterior approach, the arthroscope was inserted and inflow and outflow was established.
The synovial membrane was normal. He has some glenohumeral degenerative joint disease. In some areas even you could see the subchondral bone. Glenoid labrum was intact circumferentially. There was no evidence of biceps degeneration or tear that I could see. At this time, the rotator cuff was inspected and the retracted chronic tear was identified. This was large enough to warrant minimally open repair.
At this time the scope was removed and the patient was re-prepped and re-draped using a beach chair position. Following that through an anterior approach an incisiion was made and was taken down through the subcutaneous tissue using a muscle splitting approach between the medial and lateral head of the deltoid. The approach was made towards the subacromial space. The coracoacromial ligament was excised and the anterior edge of the acromion was exposed. At this time decompression acromioplasty and resection of the anterior edge of the acromioin was exposed. At this time decompression acriomioplasty and resection of the osteophytes underneath the AC joint was done. A bursectomy was carried out. Full thickness rotator cuff tear with almost about a centimeter and a half retraction was noted. The edges were freshened up. The foot plate of the rotator cuff on the greater tuberosity was prepared. At this time using absorbable screw anchor sutures were used for a second row repair of the rotator cuff. AT the end fixation was excellent. The shoulder was taken to a full range of motion with no evidence of impingement and the repair was excellent. Irrigation and primary closure and dressing was applied. An arm sling was applied. The patient tolerated the procedure well and left the operating room in a stable condition. There were no complications through this procedure.
Now, do you think he should be able to charge all 3 codes? I have fought this before and lost, I code this surgery (with the understanding that it may or may not pay) 23412, 23130-59. Now he wants to add in the 29805 diagnostic arthroscopy. I am on the fence with this one. I see where he thinks it should, but everything I have read indicates that if the surgery turns into an open procedure, that's what you code.
Any opinions out there? Please? All are welcome! I need some discussion on this so I know where I'm going! whether I'm on the right track, or not. Thanks!
