doc performed a shoulder arthrogram, with an articular joint injection and manipulation under anesthesia for adhesive capsulitis. He wants to bill 23350, 20610 & 23700.
I know all of these can't be billed altogether but at the same time i'm not sure which ones to bill? I'm thinking just 23700 because the reason why patient came in was for adhesive capsulitis, so i think the joint injection is bundled and as far as the arthrogram, this is not properly documented/supported anyway.
HISTORY AND INDICATIONS:
Marcela is a 49 year old female who was injured in a motor vehicle pedestrian accident on February 15, 2011. She was struck by a motor vehicle and suffered a left shoulder injury with a shoulder dislocation. This was reduced in the emergency room; however, she developed an adhesive capsulitis in the left shoulder with significant limitation of motion despite substantial amount of physical therapy. Because of her lack of response to physical therapy, a plan was to perform an arthrogram with followup intraarticular steroid injection to give her some pain relief and then manipulate her under sedation and the local.
The patient was brought into the OR. She was placed in a radiolucent table with her arm by her side. We then prepped and draped in the usual strict sterile manner. We oblique the C arm to get a true AP view of the left shoulder. After prepping and draping, we then injected local in the skin overlying the shoulder joint. We then slowly threaded a 22-gauge spinal needle into the shoulder under fluoroscopic guidance. We confirmed placement with arthrography. The arthrogram also revealed that there is a lack of normal inferior recess or pouch consistent with adhesive capsulitis. Once we confirmed successful intraarticular placement in the arthrogram we then injected 80 mg of Depo-Medrol and 3 cc of 0.5% Marcaine into the joint. I saw the dye layered out and it did not track outside the joint into the subacromial space. There was no sign of cuff tear. We then withdrew the needle and then I manipulated the left shoulder raising it overhead and also passively externally rotating her and a nice abductor position. We felt adhesions were let go and she had better overhead elevation and external rotation upon completion of manipulation. Pre Manipulation in 90 degree flexion position showing about 45 and 50 degrees of external rotation. Upon completion, she was near 90 degrees. She returned to the recovery room in stable condition.
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