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Thread: Please help with shoulder sgy

  1. #1

    Default Please help with shoulder sgy

    AAPC: Back to School
    2. DX: adhesive capsulitis, partial tear of the RC and impingement
    syndrome plus osteoarthritis of distal clavicle. 726.0, (726.19 or
    840.4), 726.2 & 715.31

    A posterior portal used and under direct visualization with 18 gauge
    spinal needle through extensive scar tissue, where the glenoid was
    unable to be visualized but repressing of the subscapular tendon, an
    18 gauge spinal needle was identified and dilated to an 8mm cannula.
    once this was accomplished the beginning of the lysis of adhesions of
    the rotator cuff subscapularis interval between the capsule and the
    labrum anteriorly, superiorly and posteriorly. Prior to this, the
    patient was manipulated to full forward flexion, abduction and an
    external rotation. Once this was accomplished a curved shaver was
    introduced to debride the partial rotator cuff tear at the insertion
    of the supraspinatus. Once this was accomplished the arthroscope was
    redirected into the subacromial space, which again was scarred in with
    adhesive scarring of the bursa. This was debrided with a bipolar
    radiofrequency wand. blood vessels were electrocauterized with the
    bipolar radiofrequency wand an dsoft tissue was removed from bursa.
    Subacromial space and the acromiocoracoid ligament were resected.
    Soft tissue ws removed from the distal clavicle which revealed
    osteoarthritis and 8mm resected, and the arthroscope was then shifted
    to the lateral portall through the posterior portal an anterior
    acromioplasty was performed and resection of the distal clavicle was
    performed with unsheate burr and the tear of the rotator cuff that was
    partial was sutured from anterior to posterior through the cannula
    with a 45 degree suture passer and a #1 prolene suture. It was
    retrieved from the posterior portal through the anterior cannula and a
    knot pusher was placed on both sides.

    Also Would I use 726.0 for intraarticular adhesions? & 726.2 for
    shoulder impingement/RC impingement . I heard somewhere that 726.2
    should be used for shoulder impingement but for RC impingement , I
    should use 726.10

    thank you!

  2. #2


    For the sake of surgery coding I generally code the diagnosis codes in order with the procedure codes; you'll be billing 29827 for RCR, 29826-51 for ASD, 29824 for DCR, and you can also try coding 29825-59 for lysis of adhesions although it's bundled with the other codes it sounds like their was some excessive scarring. So in the same order I would code 726.10, 726.2, 715.91, 726.0. Otherwise for impingement I'd code the primary cause first (726.10 or 715.91) than code 726.2 following that. If an injection is given during an office visit you can than use 726.10 or 715.91 for the visit with a modifier 25 and than use 726.2 for the injection.

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