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Ortho coders I need your input!

  1. Cool Ortho coders I need your input!
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    I wanted to get others opinions in regards to what codes you feel should go with this op report. I work at an ASC.

    The surgeon's office coded as 29806 & 29823
    I used 29806 & 29822 (I didn't feel it justified an extensive debridement but maybe I am wrong???)

    Of course, now they are denying the second procedure but yet the doctor was paid for both so in order for me to possibly appeal it, I wanted others thoughts. Here it is.....

    Right recurrent anterior shoulder dislocations with Bankart lesion.

    Right recurrent anterior shoulder dislocations with Bankart lesion.

    1. Right shoulder arthroscopy with débridement of labrum and capsule.
    2. Arthroscopic Bankart repair with anterior capsulorrhaphy.

    xxxxx is a boy who sustained first time traumatic right anterior shoulder dislocation about eight months ago while boxing. He has had recurrent instability since and an MRI arthrogram showing a prominent anterior Bankart lesion. He is indicated for repair.

    Exam under anesthesia revealed a full range of motion. He had increased anterior glenohumeral laxity with no reproducible clunk. Arthroscopic examination of the glenohumeral joint revealed the rotator cuff to be intact. The biceps was intact and stable within the groove. There was a band of tissue from the superior glenohumeral ligament extending around the biceps as it entered the groove. There was no instability at the biceps. The subscapularis was intact. There was an anterior Bankart lesion extending from the 5:30 position up to the anterosuperior labrum. This continued as a meniscoid type superior labral attachment without evidence of pathologic detachment or instability of the biceps anchor. The posterior labrum was intact. There was a small posterior Hill-Sachs lesion that did not appear to be clinically significant. The articular surfaces were intact.

    Following induction of general anesthesia, the patient was placed in the lateral decubitus position with the right shoulder up. The right shoulder and upper extremity were prepped and draped in the usual fashion and suspended from 8 pounds of longitudinal traction as well as intermittent lateral traction. Standard posterior and anterior portals were established and diagnostic arthroscopy was performed with the findings as above. Subsequently, an anteroinferior portal was also established to aid in the Bankart repair.

    Attention was first focussed on debridement of the labrum and capsule. The shaver was used to debride the superior and anterior labrum and was also used to freshen the anterior and inferior capsule extending into the axillary pouch. Next, the working cannula was placed anteroinferiorly and viewing was done anterosuperiorly. The elevator was used to free up the torn anterior labrum. The shaver was then used to freshen the anterior and inferior glenohumeral neck down the bleeding bone. The arthroscope was then placed again posteriorly and the repair was done using PushLock anchors. A lasso was used to grasp anteroinferior capsule as well as anteroinferior labrum to affect an appropriate capsular shift and labral repair. Cinch stitch was placed in this fashion. The guide was then used to drill for the PushLock anchor at approximately the 4:30 position anteriorly. The anchor was then placed and provided a good solid repair of the anteroinferior labrum. Next, a lasso was again used to place a cinch stitch through the middle glenohumeral ligament and the midportion of the anterior labrum. The PushLock was drilled. It was about to 3 o'clock position and the anchor was placed. This completed the repair of the anterior labrum as well as the anterior capsular shift. A good solid repair was obtained with a good anterior bump.

    The arthroscope was withdrawn. The portals were closed with nylon sutures and 30 cc of 0.25% Marcaine with epinephrine was instilled into the subacromial space. A sterile dressing was applied followed by a sling. The patient was awakened and extubated in the operating room and transferred to the recovery room in stable condition.

    Please, any input is greatly appreciated.

  2. #2
    Hi Susan,

    I agree with you, I don't see an extensive debridement either. Did you use the -59 modifier on the 29822? If not then I would add that and submit a corrected claim otherwise definitely appeal.

    hope this helps

  3. Wink
    Thanks Mary! I actually had to append a 51 modifier because that's what our Medicaid contract requires (I know that's strange). I have a feeling they still won't pay because the surgeon's office used 29823. I am still going to appeal though with the op report and hope for the best.

    Chat with you soon!

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