Shoulder Surgery Rotator/Biceps

cwilson3333

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Hamilton, VA
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Operation Performed:
1. Arthroscopy left shoulder
2. Subacromial Decompression
3. Labral Debridement
4. Biceps Tenodesis
5. Mini-open Repair of 6-Square cm rotator cuff tear.

I billed out:
23412
29822
29826

Both scope procedures denied as being inclusive to 23412. I looked over op note again,
and doctor states that for a biceps tendon tear: "biceps tendon was taken up from its sheath and the biceps tunnel. Biceps tunnel was prepared in usual manner with a bur, and then the biceps tenodesis was performed, incorporating it into the rotator cuff repair."

Could I have billed 24340 for the biceps tenodesis?

Debridement was performed in the glenohumeral joint arthroscopically and decompression
arthroscopically?

Okay, all you shoulder specialists, give me an answer, and thanks.

CW
 

nyyankees

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Long Island/New York
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Operation Performed:
1. Arthroscopy left shoulder
2. Subacromial Decompression
3. Labral Debridement
4. Biceps Tenodesis
5. Mini-open Repair of 6-Square cm rotator cuff tear.

I billed out:
23412
29822
29826

Both scope procedures denied as being inclusive to 23412. I looked over op note again,
and doctor states that for a biceps tendon tear: "biceps tendon was taken up from its sheath and the biceps tunnel. Biceps tunnel was prepared in usual manner with a bur, and then the biceps tenodesis was performed, incorporating it into the rotator cuff repair."

Could I have billed 24340 for the biceps tenodesis?

Debridement was performed in the glenohumeral joint arthroscopically and decompression
arthroscopically?

Okay, all you shoulder specialists, give me an answer, and thanks.

CW
Yes you could capture 23430 (Open biceps tenodesis)...but you'll need a 59 mod 29822 and possibly 29826 what is ins carrier?
 

scooter1

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Winter Springs, FL
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It is my understanding that you cannot bill 29826 with an open rotator cuff repair.

This is according to my Orthopedic Coder's Pink Sheet March 2012 volume 13 issue 3

States:
CPT no longer permits you to report 29826 in conjunction with open procedure codes (e.g. open rotator cuff repair codes, 23410, 23412 ) . Instead, the AMA now recommends the use of either 29822, or 29823.
 

OCD_coder

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Nashville AAPC Chapter
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Orthopedic Pink Sheets

Year: 2012

Issue: February 23

Title: CPT 2012: Here are some answers to the 29826 muddle

Subtype: Orthopedic



Body: If you've been feeling confused about how to bill your shoulder procedures now that CPT 2012 has revised 29826 (decompression of subacromial space with partial acromioplasty) to be an add-on code, you're not alone.

The change has had a ripple effect with payers (particularly Medicare), the AMA and plenty of your fellow orthopedic practices around the country. Here is what we currently know:

Stand-alone partial acromioplasty: There now is no specific CPT code to report for this service. At first it appeared that you'd have to report the unlisted arthroscopy code, 29999. However, the Arthroscopy Association of North America (AANA) advocates the use of one of the other arthroscopy codes: “For those few patients in the Medicare population that have an acromioplasty alone, it will have to be reported with an additional index code. There has been discussions among the members of the Coding, Coverage and Reimbursement Committee of the AAOS that the most appropriate codes to use are 29822 (limited debridement) or 29823 (extensive debridement) depending on the extent of the work involved,” the association states on its website.

CPT directs you to report 29826 as an add-on code with 29806-29825, 29827 and 29828. That means it would not be appropriate to report 29826 as an add-on with 29805 (diagnostic shoulder arthroscopy), as AANA had suggested earlier.

Bottom line: You'll have to check with payers about how they'd like you to report these services, says OCPS technical editor Margie Scalley Vaught, CPC, CPC-H,
CCS-P, MCS-PO, ACS-EM, ACS-OR.

Note that CPT changes apply to all payers, not just Medicare.

Scope acromioplasty with open rotator cuff repair: CPT no longer permits you to report 29826 in conjunction with open procedure codes (e.g., open rotator cuff repair codes, 23410, 23412). Instead, the AMA now recommends the use of either 29822 (limited debridement) or 29823 (extensive debridement).

My take:
Because the debridement of the labrum and acromioplasty took place at the same Sx, I would use the 29823 as they are two different areas by shoulder joint definition. And not used the 29826 at all per the Pink sheet information.

I don't think I could defend using the open biceps tenodesis code as it appears to be prep work for the rotator cuff, but there isn't enough information from the Op Report to argue that point. Just beware that the insurance my take that opinion.
 
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