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Shoulder codes 29821/29824

  1. Default Shoulder codes 29821/29824
    Medical Coding Books
    Can these two codes be billed together with a modifier on 29821 based on this OP note? I just struggle when it comes to shoulder coding. Thanks.



    PREOPERATIVE DIAGNOSES:
    1. Right shoulder rotator cuff impingement.
    2. Acromioclavicular joint arthropathy.
    3. Biceps tendinopathy.
    4. Glenoid labrum tear.

    OPERATIONS:
    1. Right shoulder arthroscopic subacromial decompression.
    2. Right shoulder arthroscopic acromioclavicular joint resection through a separate anterior portal.
    3. Biceps tenodesis using luggage-tag configuration to the rotator interval.
    4. Glenoid labrum debridement.

    COMPLICATIONS: None.

    DISPOSITION: Stable to recovery room.

    DESCRIPTION OF PROCEDURE: After induction of anesthesia and administration of IV antibiotics, surgical pause was conducted. The patient was examined supine and seemed to have symmetrical glenohumeral rotational range of motion comparable to contralateral side. The right arm was prepped, draped, and placed in arthroscopic arm holder. A standard posterolateral arthroscopy portal was established. Diagnostic arthroscopy ensued. This showed the rotator cuff was grossly intact. The long head of the biceps brachii was probed and seemed to be frayed and degenerative both intra-articularly as well as in the bicipital groove. I therefore placed a locking stitch around it and then released off the supraglenoid tubercle and superior glenoid labrum. I then debrided the labrum extensively, anterosuperiorly, and posteriorly as well as posterior superiorly. There was no area that appeared during this repair. I also performed a synovectomy. I then entered the subacromial space. A complete bursectomy was performed. Coracoacromial ligament was released. I then performed decompression with high-speed burr removing any impinging osteophytes from the undersurface of the acromion. The rotator cuff was intact without evidence of a defect on either articular or bursal site. I then tied down our sutures from the biceps tenodesis and then debrided the acromioclavicular joint. I removed about 8-mm of distal clavicle. At the conclusion of this, all debris, fluid, and instruments were removed. I then closed portals with subcuticular sutures and Steri-Strips. The patient had sterile dressings placed and was returned to the recovery room without incident.

  2. #2
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    Long Island/New York
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    Default
    Quote Originally Posted by skorkfranks View Post
    Can these two codes be billed together with a modifier on 29821 based on this OP note? I just struggle when it comes to shoulder coding. Thanks.



    PREOPERATIVE DIAGNOSES:
    1. Right shoulder rotator cuff impingement.
    2. Acromioclavicular joint arthropathy.
    3. Biceps tendinopathy.
    4. Glenoid labrum tear.

    OPERATIONS:
    1. Right shoulder arthroscopic subacromial decompression.
    2. Right shoulder arthroscopic acromioclavicular joint resection through a separate anterior portal.
    3. Biceps tenodesis using luggage-tag configuration to the rotator interval.
    4. Glenoid labrum debridement.

    COMPLICATIONS: None.

    DISPOSITION: Stable to recovery room.

    DESCRIPTION OF PROCEDURE: After induction of anesthesia and administration of IV antibiotics, surgical pause was conducted. The patient was examined supine and seemed to have symmetrical glenohumeral rotational range of motion comparable to contralateral side. The right arm was prepped, draped, and placed in arthroscopic arm holder. A standard posterolateral arthroscopy portal was established. Diagnostic arthroscopy ensued. This showed the rotator cuff was grossly intact. The long head of the biceps brachii was probed and seemed to be frayed and degenerative both intra-articularly as well as in the bicipital groove. I therefore placed a locking stitch around it and then released off the supraglenoid tubercle and superior glenoid labrum. I then debrided the labrum extensively, anterosuperiorly, and posteriorly as well as posterior superiorly. There was no area that appeared during this repair. I also performed a synovectomy. I then entered the subacromial space. A complete bursectomy was performed. Coracoacromial ligament was released. I then performed decompression with high-speed burr removing any impinging osteophytes from the undersurface of the acromion. The rotator cuff was intact without evidence of a defect on either articular or bursal site. I then tied down our sutures from the biceps tenodesis and then debrided the acromioclavicular joint. I removed about 8-mm of distal clavicle. At the conclusion of this, all debris, fluid, and instruments were removed. I then closed portals with subcuticular sutures and Steri-Strips. The patient had sterile dressings placed and was returned to the recovery room without incident.
    what i see is 29826 (decompression), 29824 (distal excision) and I'm thinking 29822-59 for labral debridement. Anyoen else?

  3. Default
    What about the biceps tenodesis? 29828?

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