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Thread: Shoulder/knee scope?? PLEASE HELP

  1. #1

    Default Shoulder/knee scope?? PLEASE HELP

    AAPC: Back to School
    Hi Everyone

    I am looking for some claification re debridement in both the shoulder and knee done arthroscopy. Here are two op-notes the first one is of the knee.

    The scope was introduced through an anterior lateral portal. Anterior medial portal was establisehed under spinal needle guidance. This immediately demonstrated a small tear of the posterior horn of the medial meniscus which was a small flap tear which was then trimmed involving the inner, probabley thir of the posterior horn and medial meniscus. The rest of the undersurface, superior surface and the medial middle third and anterior thire were completely stable. Once this was complete I then probe examining ACL and PCL. The lateral compartment was completely within normal limits. No evidence of meniscal tears. There is some mild chondromalacia within the medial facet of the patella, separate compartment and a mild chondroplasty was performed and then a major synovectomy was performed in all compartments.

    We billed 29881 29876 G0289 and received payment for 29881 29876 only. Is this correct. Eob states G0289 inclulded in 29876 because synovectomy was done in all compartments. Claim was billed to local MA carrier Fallon

    I am confused but trying very hard to understand. The knee has 3 compratments medial lateral patella. If you are in all 3 compartments for the major synovectomy you can not bill sep. for G0289 because you were already in that compartmemnt. Is this correct? Or should we appeal the G0289 for the patella sep. compartment.

    Any help or material to reference will be apprecaited.

    Now second op-note shoulder scope.

    The scope was introduced through and anterior portal. An anterior superior portal and cannula were placed medially demonstrating significant chondromalacia, Grade 2 to Grade 3, on the anterior few mm. and entire glenoid. The labrum was not grossly torn off. I debrided it only. There were multiple chondral loose bodies in the axillary recess and, therefore, a 7 mm. cannula was placed over the top of the subscapularis to be able to grasp there and then working with tools to decrease the size as well as bur down the size, these were then individually removed through the inferior cannula through a separate portal.

    I then did an arthroscopic capsular release anteriorly, posteriorly and inferiorly using a duck bill basket and oscillating shaver as well as a hook probe to gain motion back in her arthritic shoulder. I then subsequently extensively debrided the labrum superiortly and posteriorly. There was a full thickness tear noted of the supraspinatus as well and because of the superior labral tear I, therefore, tenodesed the biceps tendon using the soft tissue technique between the supraspinatus and subscapularis using Orthocord and PDS. This was then released and debrided back to stable rim.

    Once this was complete, the scope was then placed into the subacromial space. Arthroscopic subacromial decompression was then performed by working first from the lateral and then a posterior portal in a cutting block technique to create a Type 1 acromion and perihumeral debridement and bursectomy were performed.

    Distal clavicle excision- the scope was introduced. The bur was then used posteriorly, then laterally, then anteriorly to excised 10mm. of th distal clavicle, leaving the superior and as much of the posterior ligaments intact for post resection stability of the acromioclavicular joint.

    Once this was completed, attention was placed on the rotator cuff repair. The tear was minimally retracted. It was involed pirimarily with the supraspinatus and therefore, a 5mm. Fasten RC was then placed just off the articular surface, in which both pairs of sutures were brought through in mattress fashion and then tied down. A second anchor was then placed laterally and subsequently these were then placed in simple fashion to roll the edges of the tendon down to bone. Excellent fixation was able to be achieved.

    We billed 29827 29828 29826/51 29824/51 29823 29819 to our local Blue Shied carrier, and received payment for 29827 29828 29826 29824.

    I am not sure if we should appeal the 29823 and 29819.

    What constututes and extensive debridedment is it the different compartment, or the extent of debridement in any one compartment.

    Also the loose body removal Dr. state 7mm cannula was placed, I beleave 5mm or greater is supportive for sep. payment. Am I correct with this.

    So my question is, are we justified in appealing both of these codes or not.

    PLEASE HELP so I can have a better understanding.


  2. #2
    Join Date
    Apr 2007
    Long Island/New York


    In reagrds to the knee you performed a menisectomy in the medial compartment (29881) and then a major synovectomy (29876) that represents the patella compartment and the lateral compartment. The G0289 would NOT be reimburseable due to the fact it was paid via the synovectomy. You can't get paid for a chondroplasty (G0289) and synovectomy (29876) for the SAME compartment.

    Hope this helps with the knee procedure. I would w/o the G code as bundled.

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