Superior Capsular Reconstruction ?

scooter1

Expert
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397
Location
Winter Springs, FL
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This is the first time I am seeing an open Superior Capsular Reconstruction. I am not sure what code(s)
to use for this procedure. Am needing to get precert ( procedure not yet performed). Doctor stated he was
going to try to do a rotator cuff repair, but feels he will probably have to do the Superior Capsular Reconstruction
instead. So would like to get authorization for both procedures . . . .
I researched the procedure, but not really finding a codes that sounds like it fits.
Has anyone else had experience with coding a Superior Capsular Reconstruction?
Would appreciate any help and suggestions.
Thank you
 

Orthocoderpgu

True Blue
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1,607
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Salt Lake City, UT
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I came across this recently too. There is no code for the superior capsule reconstruction. They take some tissue from the glenoid and move it over the top of the humeral head and then anchor it down. This procedure is performed when a RTC repair is not possible. I think I used the unlisted code with 29827 as the comparison code since in a RTC repair they anchor the tendon back down to the bone too. If it's open then 23412. If anyone else has come across this, please let us know how you coded this.
 
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sxcoder1

Guru
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Our Arthrex rep said they use CPT 29806-22 and we also used 15777 for the dermal graft. I have no idea if this is correct. I'd appreciate any input also!
 
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