Blue Shield is doing some takebacks - guess I really need to understand better some of this coding with the debridements and the labral/SLAP repairs. Any advice will be greatly appreciated.


Can you guys please look at these two op notes and tell me if 29822 is incidental to 29807 and then please explain to me why - I thought I read all about the utilization of these codes but apparently I have missed the boat cuz they are taking back on both as incidental.

This scenario they are saying that 29807 is incidental when used with 29822!!

IT WAS INITIALLY CODED AS: 29826, 29807 and 29822-59

PREOPERATIVE DIAGNOSIS: Right shoulder adhesive capsulitis and labral

POSTOPERATIVE DIAGNOSIS: Right shoulder adhesive capsulitis and labral

OPERATION PERFORMED: Right shoulder arthroscopy, manipulation, rotator
cuff debridement, superior labral repair. Subacromial decompression.
Rotator cuff debridement. Removal of loose bodies.

Examination of the joint showed grade 3-4 changes posteriorly
along the glenoid in the upper outer quadrant. The grade 2 changes along
the humeral head. There was a Hill-Sacks defect posteriorly. There was
labral fraying and detachment of the superior biceps anchor superiorly.
Subscapular tendon was intact. There was a rotator cuff tear with 20% of
the greater tuberosity exposed. The rest of it was intact. This was
confirmed from above also and looking ino the subacromial space. The 35 mm
full radius shaver was used to perform a debridement of the labrum and the
rotator cuff. The biosuture tack was placed into the superior glenoid and
superior labrum was repaired. The rotator cuff was debrided also with a 35
shaver, exposing the 20% of the greater tuberosity. 80% was attached.
Attention was then directed towards the subacromial space, where
bursectomy was carried out. Subacromial decompression was carried out. The shoulder was also manipulated to allow for improved motion. In the
glenohumeral space, the 2 cartilaginous loose bodies were also removed
with the shaver.


IT WAS CODED AS 29826, 29807, 29822-59 -

PREOPERATIVE DIAGNOSIS: Right shoulder impingement syndrome.

POSTOPERATIVE DIAGNOSIS: Right shoulder impingement syndrome plus SLAP lesion type 2.

OPERATION PERFORMED: Right shoulder examination under anesthesia, right shoulder glenohumeral arthroscopy, chondroplasty, partial synovectomy, repair of SLAP lesion and subacromial decompression.
A right arm scalene block
was given in the holding area. One gram of IV Ancef was given
preoperatively within one hour of incision. The patient was placed supine
on the operating room table. After adequate general anesthesia was
obtained, the patient's right shoulder was examined and had full range of
motion. No evidence of any instability. The patient was then placed in
the left lateral decubitus position. Right upper extremity was then
placed in traction with 20 degrees of forward elevation and 45 degrees of
abduction. All bony prominences were well-padded. Axillary roll was
placed. The right shoulder was then prepped and draped in the standard
surgical fashion. While using the standard posterior portal, the site was
preinjected with local anesthetic. Stab incision was made. Arthroscope
was inserted into the glenohumeral joint. There was noted to be a fair
amount of synovitis within the rotator interval. There was noted to be a
large superior labrum which appeared to be severely detached. There was
noted to be a Buford complex. Subscapularis was intact. Rotator cuff was
intact. There was noted to be grade 4 chondromalacia in the humeral head.
The bare spot in the glenoid was within normal limits. The crescentic
area in the rotator cuff was within normal limits. Using the anterior-
superior portal from the inside-out technique, a cannula was inserted. A
synovectomy afforded visualization. The labrum was debrided. A
chondroplasty was performed with the 4.5 curved incisor. The biceps
anchor was probed and noted to be detached. Therefore, it was decided to
proceed with a SLAP repair. Using the 4.5 incisor blade, the superior
glenoid was repaired. Another cannula was inserted in the anterior mid
glenoid portal and then at the 12 o'clock position of the glenoid this was
drilled and a 2.0 Bio-SutureTak double-loaded was inserted. Using a 90
degree suture lasso, simple sutures were passed from the posterior biceps
and then in the anterior biceps and this was tied with a modified rotator
knot backed up by two half-hitches for good knot security and good loop
security. The stable repair was performed. The attention was directed to
the subacromial space using direct lateral portal 3 cm on visualizing the
acromion the cannula was inserted. Subacromial bursectomy was performed with an ArthroCare wand and a shaver. The coracoacromial ligament was peeled off the anterior edge of the acromion and noted to be a type 2 acromion. An acromioplasty was performed taking a type 2 and type 1 acromion. The rotator cuff was noted to be intact. A complete bursectomy was performed. There was no evidence of any bursal sided rotator cuff tear. Good hemostasis obtained with the ArthroCare wand. The acromioplasty was performed with the direct lateral approach. The AC joint was left intact. All the excess debris and fluid was suctioned out.