Question Rotator Interval Closure? CPT?

cclarson

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This is my first time seeing a rotator interval closure, and I'm not sure how I should code it? I'm thinking of either 29806 or 29999 with 29806 as the comparison code. Also, would I be able to code the debridement separately? Personally I think the debridement would be bundled.

Also, while trying to research this procedure, I found this:
Sometimes the rotator interval is closed to address instability. If this is the only procedure done, use code 29806 (Arthroscopy, shoulder, surgical, capsulorrhaphy). If other capsulorrhaphy procedures are performed to address the instability, the rotator cuff interval closure is included in the capsulorrhaphy and should not be coded separately. It is inappropriate to report a rotator interval closure with a rotator cuff repair.

Here is the report:

POSTOPERATIVE DIAGNOSIS:
Right shoulder subacromial impingement and rotator interval defect with previous rotator cuff repair.

PROCEDURES PERFORMED:
Right shoulder arthroscopic rotator interval closure with extensive debridement of the subacromial space.

INDICATIONS FOR PROCEDURE:
The patient is a 49-year-old male who I performed a right shoulder arthroscopic subacromial decompression and distal clavicle excision, labral debridement, open subpectoral biceps tenodesis on about a year and a half ago. He continued to experience pain and dysfunction in his shoulder. Postoperative imaging showed a persistent rotator interval defect. I did not have any other explanation for his symptoms as he continued to have pain and soreness. He had a second opinion from another physician who agreed that rotator interval closure was likely the only thing that would help relieve his symptoms. I recommended arthroscopic debridement of any subacromial adhesions with attempted closure of his rotator interval defect. The risks, benefits, and alternatives to surgery were discussed with the patient including risk of bleeding, infection, failure of any repairs, continued shoulder pain and dysfunction, and possible need for more surgery postoperatively. The patient understood all these risks and agreed to proceed with surgery.

DESCRIPTION OF PROCEDURE:
The patient was identified and marked in the preoperative area. His H&P and consent form were signed and updated. He politely declined a regional block from the anesthesia service. He was taken to the recovery room where he was intubated and sedated and then placed in the beach chair position. His right upper extremity was prepped and draped in the normal sterile fashion. Preoperative antibiotics were given. I did inject local anesthetic around his planned portal sites as well as a suprascapular nerve block.

After a surgical timeout was performed, we started with a standard posterior portal through his previous posterior portal. We entered the glenohumeral space and then visualized the anterior portion of the joint. He did have a fairly large defect in the rotator interval from the location of his previous anterolateral portal site. I examined the rotator cuff. The subscapularis and supraspinatus were both intact. His superior labral attachment was intact. He did have a little bit of fraying of the anterior labrum which we had notice previously had had a labral tear but it was not loose. I did not think it needed any sort of repair. In fact his cyst had become smaller on his postoperative MRI, so I thought his previous debridement had done well to treat the labral issue. He did not have any significant degenerative changes in the glenohumeral joint.

At this point we moved onto repair. I started initially with trying to repair it from inside out. However, it was difficult to get my instruments in, as I was trying to use a Scorpion suture passer, so it was difficult to open the jaw wide enough but then keep it shallow enough to repair from inside out. I went up to the subacromial space, did a debridement there. His coracoacromial ligament was very thick and had scarred down with very thick cord like scar tissue. I released that off the underside of the acromion. This gave us a little bit more space. We passed sutures using the Scorpion suture passer, now first through the rotator interval tissue up to the supraspinatus and then I passed a second suture through the upper border of the subscapularis and out more laterally on the supraspinatus. We tied these sutures down sequentially and these seemed operating table close down the rotator interval defect nicely. There was a little bit of a space under the coracoid but this did have the subscapularis underneath it. I thought would fill in nicely. When we examined the rotator cuff again from above and found no defects here. Overall I was pleased with the repair of the rotator interval defect as I inserted a probe in multiple passes and could not really displace our tissue at all.

At this point we proceeded with closure. We closed the portal sites with nylon suture. Sterile dressings were applied. The patient’s arm was placed in a sling. He was awakened from anesthesia and taken to the recovery area in stable condition.
 

Orthocoderpgu

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This was answered outside of forums. The answer is 29806 w/ debridement bundled.
The debridement performed here was all done in preparation for the surgical procedure. Debridement is only reported if performed on separate anatomical structures and must be linked to pathology not related to a repair. Even then your limited on when it can be. I'm glad you got your answer. It can get frustrating when you need to code a surgery and your not sure of something.
 
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cclarson

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The debridement performed here was all done in preparation for the surgical procedure. Debridement is only reported if performed on separate anatomical structures and must be linked to pathology not related to a repair. Even then your limited on when it can be. I'm glad you got your answer. It can get frustrating when you need to code a surgery and your not sure of something.
Very true. Usually it's pretty routine at the facility I work at, but there are always those unique ones that pop up out of nowhere and confuse me, haha.
 
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