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One final shoulder question

  1. Question One final shoulder question
    Clearnace Sale
    THIS WAS A TOUGH ONE BUT I DID A LOT OF READING BEFORE SUBMITTING THIS ONE TO BLUE SHIELD. THE PHYSICIAN PERFORMED A SLAP REPAIR AND A CAPSULORRHAPHY FOR INSTABILITY. I WAS UNDER THE IMPRESSION THAT IF THE SLAP WAS ADDRESSED WITH INSTABILITY ONE COULD CODE 29807 and 29806. So, I billed a 29806, 29087 and 29826. Blue Shield is stating that the 29807 is incidental when used in conjunction with 29806 and that 29807 should be deleted.


    Type 2 superior albral tear
    Anterior labral tear and instability
    Impingement syndrome

    Right shoulder superior labral repair
    Right shoulder anterior labral repair with capsulorrhaphy
    Right shoulder subacromial decompression

    Arthroscope was introduced nto the glenohuemral joint. A diagnostic arthroscopy revealed evidence of a type 2 SLAP lesion. Biceps tendon was in good condition. Anterior labrum was in good condition. There was a positive drive-through sign. Subscapularis muscle was in good condition. Rotator cuff showed no evidence of tearing. There was evidence of a Hill-Sachs deformity of the posterior aspect of the humeral head. The axillary puch showed no loose bodies. Anterior portal was made using outside-in technique and an 18 gauge spinal needle was inserted above the superior margin of the subscapularis muscle. Eleven-blade scalpel was used to incise the skin. A 7.0 cannula was introduced in the glenohumeral joint and a probe was then introduces into the glenohumeral joint. There was evidence of an unstable, Type 2 lesion. There was evidence of an anterior labral tear with capsular laxity anteriorly. Using arthroscopic shavers, a periosteoll elevator, Arthrocare wantd and acrominizer bur, the superior aspect of the glenoid was prepared. Once this was repaired through a trans rotator cuff approach using just the guide for the 3.0 suture tack, this was inserted into the glenohumeral joint. A single, double loaded anchor was inserted into the superior aspect of the glenohumeral joint using a spinal needle through a __________ as well as off the anterior aspect of the acromion. One limb of each of stitches in the suture anchor were passed both anterior and posterior to the biceps root. There were then tied in a sequential fashion to the anterior portal using SMC knots with alternating half hitches x4. Once the repair was complete it was probed and felt to be stable. Attention was then directed to the anterior labrum. The anterior labrum was loose. Using arthroscopic probe the anterior labrum was mobilized as was the capsular tissue down to approximately the six o'clock position. A second anterior superior portal was made and a 7.0 cannula was inserted so that there were two 7.0 cannulas in the glenohumeral joint. Once the labrum was mobilized three bio-suture tacks were inserted into the anterior rim of the glenoid. One limb of each of the suture tacks was passed through the labral and capsular tissue using a 25 degree suture Lasso tight and then once the limbs of each of the stitches was passed they were tied in a sequential fashion using SMC knots with alternating half-hitches x4. Once the anterior labrum was repaired it was felt to be stable. All arthroscopic instrumentation was removed from the shoulder. The arthroscope was then introduced through the subacromial space. A lateral port was made 3 fingerbreadths down from the anterior lateral aspect of the acromion. There was evidence of bursitis. A bursectomy was performed. The undersurface of the acromion was freed of all soft tissue. A partial release of the coracoacromial ligament was performed. Then through a lateral portal using a 4.0 acromionizer bur, a subacromial decompression was performed. Once all arthroscopic work was completed . . . . .

  2. #2
    if the physician performed the capsulorrhaphy to repair the slap repair, then BCBS is correct and it would be bundled. I have had cases where the physician repaired the slap (29807) and also performed (29806) for a separate reason and have got paid. In this case it just sounds like he is performing the capsulorrhaphy to repair the injury. I would bill 29806 & 29826.
    Just my opinion though.
    Stephanie Phillips, CPC-H

  3. Default Stephi
    I reviewed the op-note with the physician - he is very reasonable. He definitely stated that there was instability that was addressed and there was a SLAP repair performed.

    Do you think I should appeal this?

    Thanks for your help!!


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