Results 1 to 3 of 3

Shoulder surgery: 29826 with 29823????

  1. Default Shoulder surgery: 29826 with 29823????
    Exam Training Packages
    Fellow coders:

    My boss in one week performed three surgical procedures and coded all three as 29826 and 29823. In each scenario - two of which are noted below. The third surgery involved a partial rotator cuff tear that he coded 29823. So there are three cases all with one diagnosis of impingement syndrome and procedure SAD 29826. The first op note the patient had glenohumeral arthritis, the second a labral tear and once again the third a rotator cuff tear. The CSI edits indicate that 29823 is bundled with 29826.

    Any help will be GREATLY appreciated. Thank you!!!

    FIRST OP-NOTE

    POSTOPERATIVE DIAGNOSIS:
    1. Left shoulder pain.
    2. Left shoulder glenohumeral joint arthritis.
    3. Left shoulder impingement.

    OPERATION PERFORMED:
    1. Left shoulder arthroscopy.
    2. Left shoulder glenohumeral joint debridement.
    3. Left shoulder subacromial decompression.

    The patient was brought into the preoperative area. Site and side were identified. There was no interscalene block administered. The patient was brought into the operating room and placed supine on the operating room table. Bony prominences were padded appropriately. General endotracheal intubation was performed. She was then placed in the beach-chair position. Examination of the left shoulder under anesthesia revealed full passive range of motion in all planes. The left upper extremity was prepped and draped in a sterile fashion. Bony landmarks of the shoulder including posterolateral, lateral and anterolateral aspects of the acromion were marked with a marking pen.
    A mark was then made 2 fingerbreadths down and 2 fingerbreadths medial
    from the posterolateral aspect of the acromion. An 18-gauge spinal needle
    was inserted into the glenohumeral joint. The joint was distended with 60
    mL of sterile saline. An 11-blade scalpel was used to incise the skin.
    An arthroscope was introduced into the posterior aspect of the
    glenohumeral joint and a diagnostic arthroscopy was begun. There was
    evidence of grade 4 chondromalacial changes over the glenoid surface.
    There were some grade 2-3 chondromalacial changes over the humeral head. These were in focal areas. No evidence of subscapularis muscle tear. The biceps tendon appeared to be in good condition. There was some tendinitis of the rotator cuff but no frank tearing. No evidence of loose bodies in the axillary pouch.
    An anterior portal was established using an outside-in technique. An 18-
    gauge spinal needle was inserted above the superior border of the
    subscapularis. An 11-blade scalpel was used to incise the skin. A 7-mm
    cannula from Arthrex was introduced into the glenohumeral joint. The
    joint was debrided using an arthroscopic shaver. Once again the biceps
    tendon was brought into the glenohumeral joint. There was no evidence of
    biceps tendon pathology. The rotator cuff was intact.

    Once all intra-articular work was complete, the arthroscope was removed
    from the glenohumeral joint and introduced into the subacromial space from
    a posterior approach. A lateral portal was established 3 fingerbreadths
    down from the anterolateral aspect of the acromion. There was evidence of
    bursitis and a bursectomy was performed. The undersurface of the acromion
    was cleared of all soft tissue using the arthroscopic shaver as well as
    the ArthroCare wand. The coracoacromial ligament was released. There was
    evidence of a large subacromial spur. From a lateral portal using a 4-0
    acromionizer bur a subacromial decompression was performed. Debridement
    of the rotator cuff was performed from the subacromial space. The arm was
    brought through both internal and external rotation. There was no
    evidence of rotator cuff tearing.

    Once all subacromial work was complete the arthroscopic instrumentation
    was removed from the shoulder.



    SECOND OP NOTE

    POSTOPERATIVE DIAGNOSIS:
    1. Right shoulder pain.
    2. Right shoulder labral tear.
    3. Right shoulder impingement with bursitis.

    OPERATION PERFORMED:
    1. Right shoulder arthroscopy.
    2. Right shoulder glenohumeral joint debridement.
    3. Right shoulder subacromial decompression.


    Site and side were identified. The interscalene block was administered
    and he was then brought into the operating room and placed supine on the
    operating room table. Bony prominences were padded appropriately and
    general endotracheal intubation was performed. He was then placed in the
    beach-chair position. Examination of the right shoulder under anesthesia
    revealed full passive range of motion in all planes. The right upper
    extremity was prepped and draped in sterile fashion. Bony landmarks of
    the shoulder including posterolateral, lateral, and anterolateral aspect
    of the acromion were marked. The AC joint and the coracoid process were
    marked as well. Then a mark was made 2 fingerbreadths down, 2 fingers
    medial from the posterolateral aspect of the acromion. An 18-gauge spinal
    needle was inserted into the glenohumeral joint. The joint was distended
    with 60 mL of sterile saline. An 11-blade scalpel was used to incise the
    skin. An arthroscope was introduced into the glenohumeral joint.
    Diagnostic arthroscopy was begun. There was no evidence of chondromalacia of the glenoid or humeral surfaces. There was evidence of superior labral tear fraying. There was no evidence of subscapularis muscle tear. Biceps tendon was in good condition. Supraspinatus tendon was in good condition. Infraspinatus tendon was in good condition. There was no evidence of loose bodies within the axillary pouch. The anterior portal was established using an outside-in technique. An 18-guage spinal needle was inserted above the superior border of the subscapularis muscle. An 11- blade scalpel was used to incise the skin. A 7-mm cannula was introduced in the glenohumeral joint. Superior labrum was debrided. It was felt to be a type II SLAP lesion but this was chronic in nature. Peel off was negative. No evidence of fraying, biceps tendon instability. Biceps tendon was brought into the shoulder. There was no evidence of biceps tendinitis. Once all intra-articular work was completed, arthroscope was introduced into the subacromial space. A lateral portal was made 3
    fingerbreadths down from the anterolateral aspect of the acromion. The 7-
    mm cannula was introduced into the subacromial space. There was evidence of abundant bursitis. A complete bursectomy was performed using arthroscopic shaver as well as the ArthroCare wand. The undersurface of the acromion was cleared of all soft tissue. From the lateral portal using 4-0 acromionizer bur, a subacromial decompression was performed. Once the decompression was completed, all bursa was removed out through the rotator cuff. Arm was brought into internal and external rotations. There was no evidence of rotator cuff tear. Once all subacromial work was completed, arthroscope was removed from the shoulder.

  2. #2
    Location
    Long Island/New York
    Posts
    1,271
    Default
    In op-report #2 all I saw a debridement of SLAP tear (840.7) to go with the SAD (29826). I would go with 29826, 29822-59 for the SLAP debridement.

    In op-report #1 I would want to know what EXACTLY he debrided in the glenohumeral joint (humeral head, etc) to go along with the RC debridement.

    If there is a separate problem (i.e. SLAP tear) that needs to be addressed outside of the SAD (29826) you can capture it. 29822 is usually for 1 soft tissue while 29823 is for multiple soft tissue.

    Anyone else?

  3. Default
    I do not believe 29823 is inclusive to 29826 check your edits again.

Similar Threads

  1. Wiki 29823 with 29826
    By Desperate Denise in forum Orthopaedics
    Replies: 9
    Last Post: 07-20-2017, 11:33 AM
  2. 29823 and 29826 29824
    By LANGLEY in forum Orthopaedics
    Replies: 4
    Last Post: 12-13-2015, 11:33 AM
  3. 23430 29826 OR 29823? Help! please...
    By MELJNBBRB in forum Orthopaedics
    Replies: 1
    Last Post: 09-17-2014, 01:17 PM
  4. Replies: 2
    Last Post: 10-20-2011, 12:32 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.