jhaleycoder
Networker
Hi-- If anyone has any insight with Dermal collagen grafting for rotator cuff. The provider states--"Given the appearance of the rotator cuff decision was made not to perform a takedown and repair. Decision was made to proceed with dermal collagen grafting of the bursal side of the rotator cuff to hopefully improve any intrinsic healing as a partial rotator cuff repair." Is CPT 29827 still applicable? Would I code 29806? Below is a copy of the op note.
The CPT codes: 29827?, 29826, 23430
Implants:
1) x2 Arthrex 3.5 pushlocks anchors x 2
2) Arthrex dermal allograft 1 mm thickness, 20 x 25 mm
3) Arthrex 1.5 Fiberstitch RC anchors x 2
Anesthesia: Regional block and General
Estimated Blood Loss: 10 mL
Complications: None
Description of Procedure: The patient identified the right shoulder as the correct extremity in the pre-operative unit. He was then brought back to the operating room. General anesthetic and IV antibiotics were administered including 2g ancef as well as 1 g of TXA. He was placed in the beach-chair position. All bony prominences were padded appropriately. The right upper extremity was prepped and draped in a sterile fashion. The shoulder was placed in a pneumatic arm holder. A time-out per protocol was performed. The shoulder was insufflated with normal saline. Posterior arthroscopic portal was established and the arthroscope was introduced. Rotator anterior interval portal was established under direct vision. The following intra-articular findings were noted on diagnostic arthroscopy.
1: Glenoid and humeral head: Intact
2: Superior labrum: Intact
3. Anterior and posterior labrum: Intact
4. Subscapularis tendon: Intact
5. Biceps tendon: Intact with tenosynovitis
6. Supraspinatus/infraspinatus: Less than 50% partial tearing to the posterior supraspinatus, anterior for spinatus
7. Synovium: Intact
8. Capsule: normal appearance
Utilizing motorized shaver of the undersurface of the rotator cuff including the supraspinatus infraspinatus was debrided. Utilizing a #1 PDS, suture was shuttled through this area of the partial tearing for later identification within the subacromial space. Given preoperative exam as well as tenosynovitis within the biceps tendon decision was made to perform a biceps tenodesis. Utilizing Leksell cautery wand the biceps was tenotomized from the superior glenoid and labrum. Any remnant tissue was debrided with a motorized shaver. Attention was then placed to the subpectoral biceps tenodesis portion of the case. Approximately 4 cm incision was made adjacent to the axillary crease. Utilizing sharp and blunt dissection the inferior portion of the pectoralis major was identified and retracted superiorly. The underlying humerus was identified as well as the long head of the biceps adjacent to the conjoined tendon and short head of the biceps. The long head of the biceps was retrieved extracorporeally. Decision was made to proceed with a biceps tenodesis. Utilizing the drill guide the bicipital groove humeral bone was roughened up to allow for a bleeding healing surface. A 1.9 mm double loaded all suture Arthrex fiber tack anchor was then drilled and placed within the bicipital groove. This had excellent fixation. 1 free and of each double loaded suture tape was then passed in a Kraków fashion through the biceps adjacent to the musculotendinous junction. The residual proximal long head of the biceps was then cut and excised. Utilizing a tension slide type technique the free suture tapes were pulled allowing apposition of the biceps to the underlying humerus. The suture tapes were then individually tied and cut. This concluded the biceps tenodesis portion of the case.
The arthroscope was removed and introduced within the subacromial space. Accessory anterolateral and posterolateral portals were established . A wide subacromial bursectomy was performed given abundant bursitis present. Utilizing a motorized bur a subacromial decompression with acromioplasty was performed allowing improve working space. The rotator cuff was thoroughly visualized and evaluated utilizing the arthroscopic probe. There was evidence of partial fraying to the bursal side of the tendon without evidence of full-thickness tear or violation of the rotator cuff. Given the appearance of the rotator cuff decision was made not to perform a takedown and repair. Decision was made to proceed with dermal collagen grafting of the bursal side of the rotator cuff to hopefully improve any intrinsic healing as a partial rotator cuff repair. Dermal allograft measured 1 mm thickness and 20 x 25 mm dimensions. This was prepared on the back table utilizing the proprietary insertion device. Utilizing a passport cannula within the established lateral portal, the graft was introduced into the subacromial space. As the graft was in the appropriate place, all inside fiber stitch suture device was utilized to place x2 1.5 mm horizontal mattress sutures within the medial portion of the graft into the rotator cuff musculature. The sutures appear to have appropriate tension and fixation. Next, the lateral suture tapes were then placed individually into 3.5 mm Arthrex push lock anchors within the lateral portion of the greater tuberosity. These had excellent fixation within the bone. This allowed appropriate tension on the dermal graft which spanned the area of partial tearing within the posterior supraspinatus/anterior for spinatus as well as majority of the tuberosity. The joint and subacromial space were evacuated of debris and fluid. Portal sites closed with 3-0 Monocryl and Steri-Strips. Dry sterile dressings and an abduction sling were applied
The CPT codes: 29827?, 29826, 23430
Implants:
1) x2 Arthrex 3.5 pushlocks anchors x 2
2) Arthrex dermal allograft 1 mm thickness, 20 x 25 mm
3) Arthrex 1.5 Fiberstitch RC anchors x 2
Anesthesia: Regional block and General
Estimated Blood Loss: 10 mL
Complications: None
Description of Procedure: The patient identified the right shoulder as the correct extremity in the pre-operative unit. He was then brought back to the operating room. General anesthetic and IV antibiotics were administered including 2g ancef as well as 1 g of TXA. He was placed in the beach-chair position. All bony prominences were padded appropriately. The right upper extremity was prepped and draped in a sterile fashion. The shoulder was placed in a pneumatic arm holder. A time-out per protocol was performed. The shoulder was insufflated with normal saline. Posterior arthroscopic portal was established and the arthroscope was introduced. Rotator anterior interval portal was established under direct vision. The following intra-articular findings were noted on diagnostic arthroscopy.
1: Glenoid and humeral head: Intact
2: Superior labrum: Intact
3. Anterior and posterior labrum: Intact
4. Subscapularis tendon: Intact
5. Biceps tendon: Intact with tenosynovitis
6. Supraspinatus/infraspinatus: Less than 50% partial tearing to the posterior supraspinatus, anterior for spinatus
7. Synovium: Intact
8. Capsule: normal appearance
Utilizing motorized shaver of the undersurface of the rotator cuff including the supraspinatus infraspinatus was debrided. Utilizing a #1 PDS, suture was shuttled through this area of the partial tearing for later identification within the subacromial space. Given preoperative exam as well as tenosynovitis within the biceps tendon decision was made to perform a biceps tenodesis. Utilizing Leksell cautery wand the biceps was tenotomized from the superior glenoid and labrum. Any remnant tissue was debrided with a motorized shaver. Attention was then placed to the subpectoral biceps tenodesis portion of the case. Approximately 4 cm incision was made adjacent to the axillary crease. Utilizing sharp and blunt dissection the inferior portion of the pectoralis major was identified and retracted superiorly. The underlying humerus was identified as well as the long head of the biceps adjacent to the conjoined tendon and short head of the biceps. The long head of the biceps was retrieved extracorporeally. Decision was made to proceed with a biceps tenodesis. Utilizing the drill guide the bicipital groove humeral bone was roughened up to allow for a bleeding healing surface. A 1.9 mm double loaded all suture Arthrex fiber tack anchor was then drilled and placed within the bicipital groove. This had excellent fixation. 1 free and of each double loaded suture tape was then passed in a Kraków fashion through the biceps adjacent to the musculotendinous junction. The residual proximal long head of the biceps was then cut and excised. Utilizing a tension slide type technique the free suture tapes were pulled allowing apposition of the biceps to the underlying humerus. The suture tapes were then individually tied and cut. This concluded the biceps tenodesis portion of the case.
The arthroscope was removed and introduced within the subacromial space. Accessory anterolateral and posterolateral portals were established . A wide subacromial bursectomy was performed given abundant bursitis present. Utilizing a motorized bur a subacromial decompression with acromioplasty was performed allowing improve working space. The rotator cuff was thoroughly visualized and evaluated utilizing the arthroscopic probe. There was evidence of partial fraying to the bursal side of the tendon without evidence of full-thickness tear or violation of the rotator cuff. Given the appearance of the rotator cuff decision was made not to perform a takedown and repair. Decision was made to proceed with dermal collagen grafting of the bursal side of the rotator cuff to hopefully improve any intrinsic healing as a partial rotator cuff repair. Dermal allograft measured 1 mm thickness and 20 x 25 mm dimensions. This was prepared on the back table utilizing the proprietary insertion device. Utilizing a passport cannula within the established lateral portal, the graft was introduced into the subacromial space. As the graft was in the appropriate place, all inside fiber stitch suture device was utilized to place x2 1.5 mm horizontal mattress sutures within the medial portion of the graft into the rotator cuff musculature. The sutures appear to have appropriate tension and fixation. Next, the lateral suture tapes were then placed individually into 3.5 mm Arthrex push lock anchors within the lateral portion of the greater tuberosity. These had excellent fixation within the bone. This allowed appropriate tension on the dermal graft which spanned the area of partial tearing within the posterior supraspinatus/anterior for spinatus as well as majority of the tuberosity. The joint and subacromial space were evacuated of debris and fluid. Portal sites closed with 3-0 Monocryl and Steri-Strips. Dry sterile dressings and an abduction sling were applied