Question superior capsule reconstruction with a rotator cuff repair??

ahodge90

Networker
Messages
30
Location
Ashland, MO
Best answers
0
I have been researching this subject for a while now and while I have concluded that an ASCR done with Dermal Allograft seems to have many different ways that people think it should be coded. I am under the belief that the ASCR with dermal allograft should probably be coded as an unlisted. What I am having a really hard time with, is the rotator cuff repair with the superior capsule reconstruction. My doc is under the belief he can code for the RTCR and the ASCR together if it is for a massive rotator cuff tear. I am thinking that when these procedures are done I should probably only code for the ASCR especially if no capsular defect is mentioned. Could someone PLEASE help me understand this???
 

Orthocoderpgu

True Blue
Messages
1,483
Location
Salt Lake City, UT
Best answers
7
I have never seen a RTC repair and an ASCR performed at the same time. These procedures are not interchangeable. In the last few years there have been articles in the HBM about these. ASCR is reported with an unlisted code. If both are documented you could bill both but I'm not sure how reimbursement would work. I'm not sure if anyone at the insurance company would be knowledgeable enough to understand both of these procedures. Just a dose of reality.
 

ahodge90

Networker
Messages
30
Location
Ashland, MO
Best answers
0
I have never seen a RTC repair and an ASCR performed at the same time. These procedures are not interchangeable. In the last few years there have been articles in the HBM about these. ASCR is reported with an unlisted code. If both are documented you could bill both but I'm not sure how reimbursement would work. I'm not sure if anyone at the insurance company would be knowledgeable enough to understand both of these procedures. Just a dose of reality.


I tried to load the op note to give you an example on this but it will not let me. Basically, I have a massive rotator cuff tear of all three areas of the cuff-infra, supra and subscap. he repairs the subscap separately and then does the SCR to repair the other two. This is where it gets confusing for me because I would think that everything is included in the ASCR thus making the RTCR incidental, right?
 

Orthocoderpgu

True Blue
Messages
1,483
Location
Salt Lake City, UT
Best answers
7
No, it would not. A SCR does not involve the tendon, nor is it any kind of tendon repair. In SCR a graft is anchored down at the proximal glenoid and humerus. I've never seen two placed at the same time. A RTC repair actually re-attaches the tendon back to the bone and restores function. This is not the case with SCR where the tendons are not involved and the procedure does not take the place of a tendon. The SCR is done when the tendon/s are not repairable. The four RTC tendons help hold the shoulder in place. When one or more tendons no longer perform that function, the humerus can migrate causing pain and other issues. For the most part the SCR holds the joint in place. I would not consider the RTC repair incidental to the SCR since each procedure is performed for a separate reason basically. Keep in mind the the SCR is not taking the place of a tendon nor repairing it.
 
Last edited:

ahodge90

Networker
Messages
30
Location
Ashland, MO
Best answers
0
No, it would not. A SCR does not involve the tendon, nor is it any kind of tendon repair. In SCR a graft is anchored down at the proximal glenoid and humerus. I've never seen two placed at the same time. A RTC repair actually re-attaches the tendon back to the bone and restores function. This is not the case with SCR where the tendons are not involved and the procedure does not take the place of a tendon. The SCR is done when the tendon/s are not repairable. The four RTC tendons help hold the shoulder in place. When one or more tendons no longer perform that function, the humerus can migrate causing pain and other issues. For the most part the SCR holds the joint in place. I would not consider the RTC repair incidental to the SCR since each procedure is performed for a separate reason basically. Keep in mind the the SCR is not taking the place of a tendon nor repairing it.
Thank you so much for this! It helped me understand this procedure so much better!! My doc does this all the time, but has always though it should be coded 29806 and 29827. I was able to show him why 29999 is used for the scr but I personally never really understand why we coded for both procedures in a case like this. Now I do. I really appreciate your help!!
 
Top