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Thread: Coding Arthroscopic Subacromial Decompression

  1. #1

    Default Coding Arthroscopic Subacromial Decompression

    Hi fellow coders!!!

    My doctors will not accept the fact that they cannot use 29826 as a stand alone.

    I am wondering how people are coding opnotes such as the one below. In this case he also does a manipulation.

    I would really like to know what everyone is using for29826 when that is all they do.

    Thank you so much!!!

    Denise

    POSTOPERATIVE DIAGNOSES:
    1. Right shoulder pain.
    2. Right shoulder secondary frozen shoulder.
    3. Right shoulder bursitis.

    PROCEDURE:
    1. Right shoulder arthroscopy.
    2. Right shoulder manipulation under anesthesia, an examination under
    anesthesia.
    3. Right shoulder arthroscopy with subacromial decompression.

    WHAT WAS DONE: The patient was brought to the preoperative area, site and
    side were identified. Interscalene block was administered. He was then
    brought in to the operating room and placed supine on the operating room
    table. Bony prominences were padded appropriately. General endotracheal
    intubation was performed. He was placed in the beachchair position.
    Examination of right shoulder under anesthesia. He had passive range of
    motion to approximately 90 to 100 degrees, abduction to 90 to 100 degrees.
    He had decreased external rotation. Manipulation under anesthesia was
    performed. Audible and palpable lysis of adhesions was appreciated. The
    patient had full passive range of motion in both forward flexion and
    abduction planes post-manipulation, was able to be placed in the abducted
    and externally rotated position. Right upper extremity was then prepped
    and draped in sterile fashion. Bony landmarks of shoulder including
    posterolateral, lateral and anterolateral aspect of the acromion were
    marked with a marking pen, coracoid process and AC joint was marked as
    well. Then, a mark was made 2 fingers down, 2 fingers medial from the
    posterolateral aspect of the acromion. An 18-gauge spinal needle was
    inserted into the glenohumeral joint. Joint was distended with 60 mL of
    sterile saline. An #11 blade scalpel was used to incise the skin.
    Arthroscope was introduced in the posterior aspect of glenohumeral joint
    and a diagnostic arthroscopy was begun. There was no evidence of
    chondromalacia over the glenoid or humeral surfaces. There was evidence of
    erythema involving the capsule. There was no evidence of superior labral
    tear. Subscapularis muscle was in good condition. Biceps tendon was in
    good condition. The rotator cuff was inspected, supraspinatus,
    infraspinatus tears minor, tendon showed no evidence of articular-sided
    tearing. There was no evidence of loose bodies in the axillary pouch. No
    evidence of posterior or inferior labral tear. Once all intraarticular
    work was complete, arthroscope was introduced in subacromial space. There
    was evidence of abundant bursitis. A lateral portal was established 3
    fingers down from the anterolateral aspect of the acromion. A 7-0 cannula
    from Arthrex introduced into the space. A complete bursectomy was
    performed. The rotator cuff was inspected from the bursal side, both
    internal and external rotation. There was no evidence of rotator cuff
    tear. The undersurface of the acromion was cleared of all soft tissue.
    Coracoacromial ligament was released from a lateral portal using a 4-0
    acromionizer bur, a subacromial decompression was performed. Once
    decompression was complete, all arthroscopic instrumentation was removed
    from the shoulder, 3-0 Prolene in interrupted fashion used to approximate
    skin edges. Sterile dressings applied, sling was applied. The patient was
    awoke from general endotracheal intubation and brought to PACU in stable
    condition. He tolerated procedure well. Dr. Christiano was present
    throughout the entire procedure. The patient received 1 g of vancomycin as
    IV antibiotic prophylaxis.

  2. #2
    Join Date
    Apr 2007
    Location
    Nashville AAPC Chapter
    Posts
    937

    Default

    The AAOS advised us to use the debridement codes 29822 or 29823 depending on how the Op Report reads. Here is an article that directly quotes the AAOS on this issue.

    As of January 2012, AMA states, “CPT code 29822, Arthroscopy, shoulder, surgical; debridement, limited, or CPT code 29823, Arthroscopy, shoulder, surgical; debridement, extensive, would be reported as appropriate, when an arthroscopic subacromial decompression is the only procedure performed.”
    Link:
    http://blog.supercoder.com/coding-up...atus-of-29826/

  3. #3

    Default Ocd coder

    Thank you so much for your help.

    You are awesome to take the time to help me out.

    Have a great day!!!


    Denise

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