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Posterior AND Anterior AND Slap Repair

  1. Question Posterior AND Anterior AND Slap Repair
    Medical Coding Books
    29806 - Anterior
    29806/59 - Posterior
    29807/59 - SLAP
    29826/59 - Sub Decompression
    29823/59 - Debridement

    The above codes are what Im getting from the report. Ive never billed for so many labral repairs together, and wanted to see if any other coders that had more experience with shoulders could give me a thumbs up ont he above codes or advice in how to correctly bill for these.
    And also what ICD 9 Code I would use for the Anterior & Posterior Labral Tears. Any help is appriciated! Thanks!

    Left shoulder arthroscopy with extensive glenohumeral joint
    debridement, posterior labral repair, anterior labral repair, and
    superior labral anteroposterior repair. We also did a
    subacromial decompression.

    A probe was inserted. Diagnostic arthroscopy was performed.
    There was significant tear of the anterior, superior, and
    posterior labrums. These were identified with a probe. The
    anterior labrum was torn completely from the 7 o'clock position
    superiorly incorporating the superior labrum. There was
    disruption of the biceps tendon that was continuous with the
    superior anterior aspect of the labrum that extended up into the
    biceps tendon. The superior labrum was also torn completely with
    a type 2 SLAP. This extended posteriorly to the posterior labral
    tear that extended posteriorly to the approximate 4 o'clock
    position. There was significant debris throughout the
    glenohumeral joint. This was debrided using the 4.5 shaver.
    There was significant fraying throughout this labral tissue. It
    was all debrided using the 4.5 shaver. There was synovitis
    throughout the posterior and superior aspects of the capsule. It
    was all debrided using the 4.5 shaver. There were no loose
    bodies in the axillary pouch. The articular surfaces of both the
    humeral head and glenoid showed some grade 2 chondral change.
    There was a significant Hill-Sachs deformity noted. The
    undersurface of the rotator cuff was intact. Attention was first
    directed towards the posterior labrum. The scope was placed in
    the anterior portal and the elevator was placed in the posterior
    portal. The posterior labral tear was then elevated. Once
    adequate elevation was achieved, the tissue was appropriately
    mobilized. A rasp was then used to rough up the bone as well as
    the labral tissue. 2 JuggerKnot anchors were then placed over
    the posterior glenoid. These anchors were then used to secure
    the labral tissue to the prepared glenoid rim. Once this was
    complete, the tails were appropriately cut, arthroscopic
    instruments were then removed and the arthroscope was then placed
    in the posterior portal and attention was directed towards the
    anterior labrum. 2 JuggerKnot anchors were then placed
    inferiorly in the glenoid. Each of these anchors were then used
    to secure inferior capsular and labral tissue to the anterior
    inferior aspect of the glenoid. Then three 3.0 mm Bio-SutureTak
    anchors were then placed over the middle and anterior superior
    aspect of the glenoid. The capsular and labral tissue was then
    repaired to the glenoid. Once these knots were tied, and tails
    were appropriately cut, attention was then directed to the SLAP
    tear. The arthroscope was placed in the posterior portal. A
    trans tendinous portal was established using a spinal needle and
    a knife used to dissect through the skin and subcutaneous tissue.
    A sharp trocar was then used to place two 3.0 mm Bio-SutureTak
    anchors in both the anterior and posterior aspects of the biceps
    insertion on the superior glenoid. These were then passed around
    the labral tissue and tied sequentially. Care was taken to
    ensure appropriate reduction of the biceps anchor to the superior
    aspect of the glenoid. Once this was complete and appropriate
    tails were cut, the labral repair circumferentially was inspected
    and felt to be appropriate. Once this was complete, the
    glenohumeral joint was then copiously irrigated with normal
    saline. A spinal needle was used to place a PDS suture through
    the lateral edge of the rotator cuff. It was managed to the
    anterior portal. All the instruments were then removed from the
    glenohumeral joint and a trocar was used to redirect the cannula
    into the subacromial space. Once in the subacromial space
    through the posterior portal, a spinal needle was used to
    identify the location of the lateral portal. Once this lateral
    portal position was identified, a trocar was used to dilate the
    portal. A 5.5 shaver was then introduced. A subacromial
    decompression was performed and all bleeding points were stopped
    with electrocautery. Once this was complete, ArthroCare was used
    to resect the soft tissues on the undersurface of the acromion
    including the coracoacromial ligament. Once this was complete, a
    significant subacromial spur was noted. A 5.5 bone-cutting
    shaver was then used to perform an acromioplasty. Once this
    acromioplasty was complete, the resection was inspected and felt
    to be appropriate. All bony debris was then removed from the
    subacromial space.

  2. #2
    Columbus, Ga
    You can only bill 29806 once. I have looked at the same scenerio over and over because my physician wants to bill it out twice. There is only one capsule in the shoulder therefore, it can be charged only once. I found this in the AAOS bulletin Aug 03 - it is also qouted on this list serve. Hope that helps...

    Rachel CPC, CPC-H

  3. Default
    Yes it does help! Thanks so much!

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