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Arthroscopic plus open shoulder surgery

  1. Default Arthroscopic plus open shoulder surgery
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    Hey guys - another quick question.

    I am constantly in discussions (lets call it that) with the physicians about arthroscopic subacromial decompression and labral debridements performed with mini-open rotator cuff tears.

    I have taught that with open rotator cuff repairs (23412) the 29826 would be included in the open procedure. The 29822 in this scenario appears to be bundled with 29826.

    If you could please comment on this opnote and assist me with obtaining any literature to present to the physicians at my next meeting it would be so overwhelmingly appreciated.

    POSTOPERATIVE DIAGNOSIS: Left shoulder massive rotator cuff tear,
    impingement syndrome, labral tear.

    OPERATION PERFORMED: Left shoulder arthroscopy.
    Arthroscopic labral debridement of type 1 tear.
    Arthroscopic subacromial decompression.
    Mini open repair of massive rotator cuff tear.

    and placed supine on the operating room table. After induction of general
    anesthetic, she was placed in a beach chair position. All bony
    prominences were padded. A posterior portal was created. Examination of
    the shoulder showed normal glenohumeral articular surfaces. There was
    fraying of the superior aspect of the subscapularis tendon. The biceps
    tendon was absent intraarticularly. There was a tear extending from the
    top of the subscapularis down to the infraspinatus. The tear was a
    crescent-shaped tear and had delamination component to it. The labrum had
    a type 1 tear right at the biceps attachment which was debrided with a 4.5
    mm full-radius shaver. Attention was directed to the subacromial space
    where a type 3 acromion was visualized and acromioplasty was performed. A
    mini open rotator cuff tear was carried out with dissection down through
    skin and deltoid fascia. The superior leaf was debrided. The greater
    tuberosity was debrided with a 5.0 bur. There was blood coming from the
    greater tuberosity. The tendon edges were debrided and a traction suture
    was placed. The traction suture showed there was a crescent-shaped tear.
    No need for convergence sutures. The 5.5 PEEK anchor was placed
    posteriorly. An attempt at a 5.5 PEEK anchor was placed in the mid
    tuberosity and it pulled out. A 6.5 anchor also pulled out. A 5.5 anchor
    PEEK anchor was then placed anterior to the weak tuberosity bone. The 4
    sutures were placed in a horizontal mattress fashion. These were then
    tied down, and two 4.5 suture lock anchors were placed laterally inferior
    to the greater tuberosity. The tendon edges were brought down nicely and
    covering the footprint of the greater tuberosity. There was no tension on
    the repair. The arm could be placed at the side comfortably. The
    shoulder was irrigated. The deltoid fascia was closed with 0 Vicryl
    suture, 2-0 Vicryl in the subcutaneous tissue, 4-0 Monocryl in the skin. Steri-Strips and dry sterile dressing...

  2. Default
    only a diagnosic athroscopy is included in the open procedure

  3. #3
    You didn't include carrier information which may impact what is allowed, but take a look at this information on the subject at the AAOS website.

    It's the second or third question and seems to be pretty much the same scenario you've described.
    Last edited by coderguy1939; 06-07-2010 at 01:51 PM.

  4. Default
    I would bill this as 23412, 29826, 29822, and check CCI edits because I think one or two codes requires a 59 modifier.

  5. #5
    Monmouth, NJ & Dover, DE
    Becasue the surgeon went from arthroscopic to an open technique to complete different procedures, you can code for both. Had he started the RTC repair arthroscopically and then went to an open you could only code the open. In the orhtopedic coding alert [2010, Vol. 13 no. 4] it states just that. The arthroscopic procedures get the 59 modifier.

  6. Default Shoulder surgery
    Thank you Delphinus777, Bella Cullen, Coderguy and Doverred - I really appreciate your clarification.

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