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Arthroscopic Rotator Cuff Tear Repair...

  1. #1
    Default Arthroscopic Rotator Cuff Tear Repair...
    Medical Coding Books
    CPTs 29826, 29827, 29828, 20610...? no bundling issues?

    1. Full thickness rotator cuff tear repair with metallic suture anchors, double-loaded suture
    2. Partial acromionectomy
    3. Biceps tenodesis
    4. Resection partial-thickness, superior-surface, subcapularis tendon repair

    After the anatomy was drawon onto the skin, a posterior portal site was made after going 2 cm distal, 1 cm medial from the posterolateral acromion. A stab wound was subsequently made and the trocar subsequently placed through the stab wound into the acromial space. The arthroscope was introduced, and the subacromial space was insufflated with normal saline. After thorough observation, the anterolateral portal was made 2 cm distal to the anterolateral edge of the acromion. The exact location was located with an 18-gauge spinal needle and was seen intra-articularly. A stab wound was subsequently made in the skin, and a blunt trocar was placed to establish a working portal site. Hemostasis was obtained with electrocautery within the subacromial space throughout the case.

    The Arthrotec electrocautery wand was introduced, and the underlying soft tissues on the undersurface of the acromion was resected. Pictures were taken of the subacromial impingement. The Acromionizer was subsequently used to debride the bony undersurface of the acromion in a tapered fashion in the usual manner. It appeared that an appropriate amount of bone was removed, and the AC joint was not entered. Attempts were made to obtain pictures. The subacromial space was thoroughly irrigated, and all fluid that could be removed was remoevd.

    Through the posterior portal, because of the large size of the massive rotator cuff tear, teh edges of the rotator cuff were freshened. Soft tissues were debrided off of the greater tuberosity. With the use of an ArthroWand and 4.5 full radius resector, the long head of the biceps tendon that was torn was resected free. The superior surface of the subscapularis tendon where the partial tear was located was resected. Two metallic, double-loaded suture anchors with #2 MaxBraid blue & white were inserted to allow for side-to-side repair of the tendon as well as pulling back down to the greater tuberosity with excellent reapposition of the bony footprint. The scope was then inserted through the posterior portal into the glenohumeral joint. The joint was insufflated with normal saline. The rotator cuff footprint was noted to be reestablish nicely.

    An 18-gauge spinal needle was insered into the subacromial space. A steroid Marcaine cocktail was injected. The skin edges were re-apposed with simple interrupted 3-0 nylon suture. A sterile Adaptic and bukly gauze dressing was applied and secured with foam tape. The patient was extubated, transferred to the bed and taken to the recovery room. The patient appeared to tolerate the procedure well without apparent complications.

  2. #2
    I agree with all except the 20610, even though it shows allowed via CCI edits, which I cant for the life of me tell you why since MCR has the strict guidelines that injections are part of the global surgical package. I also think, not positive because I dont actually have the guide, but the AAOS global surgery book may also show that this is inclusive of the surgery.

    hope this helps that I just re-read the note...where is the biceps tenodesis reported? I see a resection of the biceps, but I dont see anything else....did I miss it?
    Last edited by mbort; 08-20-2009 at 10:46 AM.
    Mary, CPC, CANPC, COSC

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