tbensonite
Guest
Hi All.
So my ortho doc performed a typical arthroscopic procedure including a "shoulder rotator cuff trephination". Can someone please tell me if this should be billed out Unlisted procedure? If so, what CPT code would I compare it to for reimbursement? Or would it be a repair code with a modifier 22? We've done an unlisted code for a trephination in the medial meniscus but not the shoulder. Any suggestions?
Also, based on the amount of distal clavicle excised, I cannot capture 29824 correct? Thanks in advance.
Diagnosis:
Right shoulder impingement with AC arthrosis
Procedures Performed:
Right shoulder arthroscopy.
Right shoulder subacromial decompression.
Right shoulder distal clavicle excision.
Right shoulder anterioinferior capsular release.
Right shoulder rotator cuff trephination
PROCEDURE AND FINDINGS: The patient was taken to the operating room after appropriate site was marked and consent was obtained. She was transferred to the OR table and anesthesia was successfully induced. She was placed into the beachchair position. Head and neck were stabilized throughout. The right upper extremity was prepped and draped in the usual sterile fashion. A time-out was performed, and antibiotics were given prior to skin incision. Standard posterior portal was created. I went into the glenoid. I thoroughly evaluated the glenoid and humeral head and these were pristine. Subscapularis was normal. No evidence of loose bodies of axillary pouch. She did have some injection about the superior and anterior labra. The superior and anterior labra were well maintained.
Then, I switched posteriorly after the anterior interval portal was created. She had some mild fraying about the posterior labrum and this was gently debrided with the ArthroCare device. I then evaluated the rotator cuff. She had an area of some obvious tendinosis. We trephinated this area to stimulate blood response. The remained of the articular surface was pristine. Given the fact that she previously had issues of significant shoulder tightness, I did perform an anteroinferior capsular release going from approximately 3 o?clock to 6 o?clock position. We went down the subacromial space and subacromial sweep was performed. She had a significant amount of bursa and this was debrided. We also went down in the gutter. She was concerned that she had some anteriolateral pain and this was evaluated and all bursa was resected. We did evaluate the biceps where we were intra-articular and there was no evidence of biceps injection. It was competent. We then gently debrided the CA ligament. Then, 10 mm of anterolateral acromion was resected. I continued the dissection medially. She had significant narrowing about the AC joint. Then, 5mm of distal clavicle was removed. There was no underlying impingement. A shaver was utilized and all debris was removed. The arthroscope was removed. Portals were closed with 3-0 nylon in a whipstitch fashion. There were no apparent complications.
Thanks again for your time.
So my ortho doc performed a typical arthroscopic procedure including a "shoulder rotator cuff trephination". Can someone please tell me if this should be billed out Unlisted procedure? If so, what CPT code would I compare it to for reimbursement? Or would it be a repair code with a modifier 22? We've done an unlisted code for a trephination in the medial meniscus but not the shoulder. Any suggestions?
Also, based on the amount of distal clavicle excised, I cannot capture 29824 correct? Thanks in advance.
Diagnosis:
Right shoulder impingement with AC arthrosis
Procedures Performed:
Right shoulder arthroscopy.
Right shoulder subacromial decompression.
Right shoulder distal clavicle excision.
Right shoulder anterioinferior capsular release.
Right shoulder rotator cuff trephination
PROCEDURE AND FINDINGS: The patient was taken to the operating room after appropriate site was marked and consent was obtained. She was transferred to the OR table and anesthesia was successfully induced. She was placed into the beachchair position. Head and neck were stabilized throughout. The right upper extremity was prepped and draped in the usual sterile fashion. A time-out was performed, and antibiotics were given prior to skin incision. Standard posterior portal was created. I went into the glenoid. I thoroughly evaluated the glenoid and humeral head and these were pristine. Subscapularis was normal. No evidence of loose bodies of axillary pouch. She did have some injection about the superior and anterior labra. The superior and anterior labra were well maintained.
Then, I switched posteriorly after the anterior interval portal was created. She had some mild fraying about the posterior labrum and this was gently debrided with the ArthroCare device. I then evaluated the rotator cuff. She had an area of some obvious tendinosis. We trephinated this area to stimulate blood response. The remained of the articular surface was pristine. Given the fact that she previously had issues of significant shoulder tightness, I did perform an anteroinferior capsular release going from approximately 3 o?clock to 6 o?clock position. We went down the subacromial space and subacromial sweep was performed. She had a significant amount of bursa and this was debrided. We also went down in the gutter. She was concerned that she had some anteriolateral pain and this was evaluated and all bursa was resected. We did evaluate the biceps where we were intra-articular and there was no evidence of biceps injection. It was competent. We then gently debrided the CA ligament. Then, 10 mm of anterolateral acromion was resected. I continued the dissection medially. She had significant narrowing about the AC joint. Then, 5mm of distal clavicle was removed. There was no underlying impingement. A shaver was utilized and all debris was removed. The arthroscope was removed. Portals were closed with 3-0 nylon in a whipstitch fashion. There were no apparent complications.
Thanks again for your time.