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Help with 29826 & 23700

  1. Default Help with 29826 & 23700
    Medical Coding Books
    My orthopaedic surgeon performed 1) Arthroscopic exam of left shoulder with arthroscopically assisted subacromial decompression 2) Closed manipulation, left shoulder. Preoperative diagnosis Recurrent rotator cuff tendonitis, left shoulder. Postoperative Diagnosis: 1) Recurrent rotator cuff tendonitis, left shoulder 2)Rupture of biceps tendon 3)Adhesive capsulitis

    Operative Procedure: The patient was brought to the operating room. General anesthesia was induced. She was placed in a semi-sitting position using the beach chair attachment to the table. Exam under anesthesia showed prominent stiffness of the shoulder with passive elevation to about 80 degrees. The shoulder was manipulated first in flexion and then in rotation until normal motion was achieved. The left forequarter was prepped and drapes applied. Bony landmarks were drawn on the skin using a marking pen. A posterior glenohumeral portal was established followed by an anterior portal using Wissinger rod technique. The biceps tendon was absent. The supraspinatus was intact. There was no evidence of rotator cuff tear. There was mild degenerative fraying of the glenoid. The joint was inspected with the arthroscope in both the anterior and posterior portals.

    The arthroscope was then advanced into the subacromial bursa. A direct lateral portal was established for instrumentation in the bursa. A bursectomy was performed using motorized shavers and electrocautery. There was moderate fraying of the upper surface of the rotator cuff, but no evidence of rotator cuff tear. Soft tissues were cleared from the undersurface of the acromion using a cautery pencil. An acromioplasty was then performed using a motorized burr. The bursa was irrigated. Through a posterolateral puncture, a needle was advanced into the subacromial bursa. A catheter was placed through this needle for postoperative infiltration of local anesthetic. The incisions were closed with interrupted nylon suture. The wounds were infiltrated with Marcaine. The wounds were closed with interrupted nylon suture. The pain pump catheter was injected with a mixture of Marcaine and Xylocaine with Epinephrine. The agent used in the pain pump was 1%plain Xylocaine. The patient was transported to the recovery room in stable condition. There were no intraoperative or immediate postoperative complications. Estimated blood loss was less than 50 cc.

    My question is the procedure codes the doctor give me was 29826 which I know is an add on code and 23700 for the manipulation under anesthesia. Am I missing a procedure that could be billed to allow the 29826 to be billed? If I have, can I still bill the 23700 or is it included with the 29826?

    Janet Miller, CPC-A

  2. #2
    Default
    You will have to bill either 29822 or 29823 depending on how extensive it was since you don't have a primary code to go with the 29826. I am leaning toward the 29823. Also according to NCCI edits the closed manipulation will be bundled with the 29822 or 29823.

  3. Default Help with 29826 & 23700
    Thank you for your response. I will now discuss this with my provider. I am still fairly new with coding and appreciate your help.

  4. #4
    Default
    I would bill 29823
    Kelly A Mcfadyen, CPC

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