Shoulder Experts-I'm so confused

AR2728

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I have another arthroscopic shoulder procedure I'm struggling with. I'm trying to grasp the whole 29826/29823 use and I'm just not there yet. Your assistance would be greatly appreciated...and any suggestion for how to understand this would be helpful!
I was thinking 29827 and 29826--Would I code 29999 for bicep tenotomy or 29823?

POSTOPERATIVE DIAGNOSIS:
1. Right shoulder rotator cuff tear.
2. Right shoulder biceps tendonitis.
3. Right shoulder labral tear.
4. Right shoulder osteoarthritis.
PROCEDURE PERFORMED:
1. Right shoulder arthroscopic rotator cuff repair.
2. Right shoulder biceps tenotomy.
3. Right shoulder subacromial decompression.
4. Right shoulder labrum debridement.
...... Diagnostic arthroscopy of the right shoulder ensued.
The patient had a tear of the supraspinatus tendon. There were no loose bodies. The patient had grade III chondromalacia of the glenoid. He also had a labral tear and a partial tear of the biceps tendon with biceps tendonitis. At this point in time, the anterior portal was made. A biceps tenotomy was performed and a labral debridement was performed. At this point in time, the arthroscope was brought into the subacromial space. The lateral portal was established. A bursectomy was performed. Soft tissue was removed on the undersurface of the acromion. Once this was done, using the bur, subacromial decompression was performed converting a type II acromion to a type I. At this point in time, the rotator cuff was viewed. He had an abundant amount of bursal tissue. It appeared very friable. At this point in time, a repair was made. 2-0 orthocord was placed using marginal convergence technique bringing the anterior and posterior leaflets together. A Mitek helix anchor 5.5 mm was placed at the dead man's angle of the humerus. Several attempts were made until finally the suture did hold through the rotator cuff. As stated, the rotator cuff was very friable. The sutures were then all tied down in an arthroscopic sliding knot. Once this was done, the shoulder was moved and the humerus and rotator cuff moved as one unit. At this point in time, the shoulder was drained of the fluid. 3-0 nylon suture was used to close the skin.
 

OCD_coder

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Correct codes:
1) 29827
2) 29823-59 Use only one time, a tenotomy and labrum debridement are two different
areas and considered extensive debridement.
3) 29826

I have a job aid for the shoulders that my be helpful, message me your email address via a private message. I will not monitor this thread to catch any posting you make.

Hope that helps.

PROCEDURE PERFORMED:
1. Right shoulder arthroscopic rotator cuff repair. 29827. Right shoulder biceps tenotomy. 29823. Right shoulder subacromial decompression. 29826. Right shoulder labrum debridement. 29823
...... Diagnostic arthroscopy of the right shoulder ensued.
The patient had a tear of the supraspinatus tendon. There were no loose bodies. The patient had grade III chondromalacia of the glenoid. He also had a labral tear and a partial tear of the biceps tendon with biceps tendonitis. At this point in time, the anterior portal was made. A biceps tenotomy was performed and a labral debridement was performed. At this point in time, the arthroscope was brought into the subacromial space. The lateral portal was established. A bursectomy was performed. Soft tissue was removed on the undersurface of the acromion. Once this was done, using the bur, subacromial decompression was performed converting a type II acromion to a type I. At this point in time, the rotator cuff was viewed. He had an abundant amount of bursal tissue. It appeared very friable. At this point in time, a repair was made. 2-0 orthocord was placed using marginal convergence technique bringing the anterior and posterior leaflets together. A Mitek helix anchor 5.5 mm was placed at the dead man's angle of the humerus. Several attempts were made until finally the suture did hold through the rotator cuff. As stated, the rotator cuff was very friable. The sutures were then all tied down in an arthroscopic sliding knot. Once this was done, the shoulder was moved and the humerus and rotator cuff moved as one unit. At this point in time, the shoulder was drained of the fluid. 3-0 nylon suture was used to close the skin.
 
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OCD_coder

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The source you used does not state that an arthroscopic tenotomy should be coded as a 29999. Zupko and Associates work hand in hand with the AAOS, educating their members. Here is their very up to date and specific instructions and rationale.

February 7, 2013

Question:
Our surgeon performed and documented an arthroscopic biceps tenotomy and arthroscopic subacromial bursectomy. I read in a journal recently that the tenotomy should be reported with an unlisted code and I do not think that is right. We value the advice we receive from Mary LeGrand and Margi Maley and was wondering if they might be able to help us.

Answer:
Thanks for your comments and support of KZA! You are correct to question the advice you read as it is incorrect. An arthroscopic biceps tenotomy is not reported with an unlisted code; it is considered part of a debridement service reported with CPT code 29822 or 29823 depending on the extent of work. An arthroscopic subacromial bursectomy is not reported with CPT code 29826 but is again reported as a debridement service. Two debridement codes cannot be reported for the same surgical session, so report either 29823 or 29822 for the service encompassing the tenotomy and the bursectomy based on the surgeon's documentation.

AAOS Arthroscopic Shoulder Coding Rules:
http://www.aaos.org/news/aaosnow/apr13/managing2.asp

Remember: Just because a CPT code (29999) pays by the carrier, does not mean it is coded correctly.
 
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OCD_coder

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FYI

I am happy to send the job aid to anyone that emails me privately here on the AAPC website as I do not monitor this posting.

This job aid has been very helpful for many coders.
 

alnazz@snet.net

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Shoulder Experts, Im so confused....

I am VERY new to Orthopaedic coding:

Would you be able to assist me with Shoulder Arthroscopys?

This Dr. bills:
EUA
SHOULD ARTHROSCOPY
EXTENSIVE DEBRIDEMENT OF LABRUM AND ROTATOR CUFF
BICEPTS TENOTOMY
REPAIR OF SUBSCAPULARIS ROTATOR CUFF TEAR
ACROMIOPLASTY
REPAIR OF RETRACTED SUPRASPINATUS ROTATOR CUFF TEAR WITH DOUBLE- ROW FIXATION

Thank you,
ANazzaro@osmcenters.com
 
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