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Old 07-24-2009, 07:24 AM
nyyankees nyyankees is offline
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Default Surgery Op Help

Ok...I posted the op-report from one of my surgeons. I didn't get any CPT codes. My issue is that this Dr likes to code from a Reimbursement point of view - which always makes me nervous. Anyway I came up with the following: 23550 (for AC + CC ligament reconstruction) and 29822 (weak debridement of coracoid via scope). She doesn't agree and wants 23040 for AC joint epair, 29822 for debridement and unlisted code for "hamstring reconstruction of CC ligament. That's why I would appreciate anyone's input. Maybe I am wrong and there is a better CPT code(s) to appropriately code this surgery. Thanks.

Post-op Dx: Left Coracoclavicular Ligamentous Rupture, Grade 5

Operation: Left Shoulder Arthroscopy, debridement and Coracoclavicular Reconstruction with Arthrex Graft Rope and Hamstring Allograft with Acromioclavicular Joint Ligament Reconstruction as well.

Procedure: Posterior portal site was made after infiltrating the site with lidocaine. A diagnostic arthroscopy revealed a meniscoid and frayed superior labrum with some elevation of the biceps anchor. No evident synovistis. the rotator cuff was pristine. The remainder of the joint was pristine without evidence of osteoarthritis.

The coracoid was identified with a combination of an ArthriCare and a shaver through the rotator interval. An incision was then made for approximately 2cm in length just medial to the acromioclavicular joint. The fascia was incised longitudinally along the clavicle. 3.5cm from the lateral tip of the clavicle was marked.

The guide was then placed at the central aspect of the base of the coracoid and a drill point was made into the center aspect of the clavicle. This was over reamed to the proximal cortex, and then the clavicle with the guide in place, a guide pin was reamed up through to the central aspect of the coracoid adjacent to the base of the coracoid.

This was over reamed with 6mm reamer. Through the reamer was passed a Nitinol wire with a loop at the end. This was used to pass through a semitendinosis graft which had been prepared on the back table, looped through an Endobutton.

This graft was passed down and the Endobutton was then flipped. Tension was placed on the graft. the acromioclavicular joint was reduced and the button was laid flat down on the clavicle. The #5 FiberWire sutures were tensioned and tied securely.

A 5.5mm Arthrex tenodesis screw was used to secure the semitendinosus within the tunnel. The two limbs were passed across the acromioclavicular joint and sutured into the acromioclavicular joint capsule. The overlying fascia was repaired over the clavicle with figure-of-eight #0 Vicryl sutures.
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Old 07-27-2009, 09:49 AM
BCrandall BCrandall is offline
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I don't see a arthroscopic debridement in the note. 23040 just isn't supported. 23550, hmmm, theere wasn't really a dislocation per the note and you may have more info in the chart about this. Me, I'd go with 23929 (unlisted shoulder) and my software supports that. If you doc wants to make an addendum about the scope debridement or give you some more info, then you can use 29822/23.

Good luck!
-Bruce
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Bruce Crandall, CPC
North Carolina Specialty Hospital
Durham, NC
www.ncspecialty.com
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Old 07-28-2009, 10:16 AM
nyyankees nyyankees is offline
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Thanks. She thinks she can get 23040 + 29822 + unlisted procedure with this note. This is my big issue. I am going to offer the unlisted with 29822 (with an addendum) and that's it.

She'll want to use all 3 as is (documentation-wise). What CPT code would you use as an RVU value?
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