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Shoulder arthroscopy

  1. #1
    Loma Linda
    Default Shoulder arthroscopy
    Medical Coding Books
    Still new into this whole surgery coding. Need some guidance on this surgery for the shoulder. I was going to code a 29826, 23440 and a 29822. Is this correct? I think the debridement is inclusive with in the 29826 but wonder if i can bill seperatley?

    Description of procedure: A portal 2 cm inferior and 1 cm medial to the posterolateral corner of the acromion was used to enter the joint after the joint had been inflated via a spinal needle with 30 cc of saline with epinephrine. Once the scope was introduced into the joint an outflow portal was created using the outside-in technique starting lateral to the coracoid and entering the joint between the biceps and subscapularis. He had a torn labrum. Because he was so stiff we cound not do a biceps tenodesiss so we had to do a biceps tenotomy and the labral resection. The biceps was cut and the torn labrum was excised with a straight biter and a shaver. The articular side of the rotator cuff was torn. It was not a full thickness tear but it involved the leading edge of the supraspinatus tendon, probably forty percent of the thickness of the tendon. It was hard to see how much of the footprint was exposed but it looked like it was about 4-5mm. He ad some early degenerative changes in the glenohumeral joint. He ad grade 2 chondromalacia of the glenoid diffusely and grade 2-3 chondromalacia in the superior half of the humeral head.

    On the bursal side had marked fraying of the coracoacromial ligament and subacromial bursitis. The bursal side of the rotator cuff was normal and the modified subacromial decompression was done. A third portal was created in line with the posterior aspect of the acromioclaviclar joint and the leading edge of the acromionthat was curved was resected witha 4 mm stonecutter acromionizer going from medial to lateral until the acromion was flat anteriorly. The scope was then placed in the lateral portal for that proceudre. The scope was then placed in the posterior portal to make sure there is no lateral ridge. A shaver was used to remove the debris. After I did the biceps tenotomy and the capuslar release with a straight biter I cut the capsule at the edge of the laburm all the way down to the 6 o'clock position. The capusle was extremley thick and I cut it with one part of the biter inside the joint and the other one just below the ligament. I never did stray away from the labrum. I then placed the scope in the anterior portal and did the same thing with the posterior labrum intil the two converged. I then checked his motion and he had excellent forward flexion, abduction and external rotation.

  2. #2
    Default shoulder scope
    well the dictation is a bit different than what i am used to but i will give it my best shot !!

    This is what I am understanding the physician did:

    bicep tenotomy 29999 cannot bill to medicare or bc (at least in my area-iowa)

    debrided the labrum due to tear and capsule due to chondromalacia 29823

    decompression 29826

    all three are billable except depending on the insurance for the 29999

    i am a bit confused on this language in the AC joint starting after the biceps tenotomy and talking about the capsular release with a straight biter -- to me that means a debridement

    please let me know if i can help further

    thanks carol

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