Annette Posted Tue 18th of May, 2010 13:27:32 PM
Dr. wants to bill 29827, 29828, 29826, 29825, & 29824, but I'm thinking this is incorrect, I feel cpt 29825 should be bundled, & 29828 although there's not a whole lot documented , I think believe it can be coded.
BUT I don't think there's enough for the subacromial decompression either, 29826? What do you guys think? thanks!
DX: RC tear, biceps tendonitis, impingement syndrome, & intra-articular adhesions
Procedure: Arthroscopic lysis of adhesions, rotator cuff repair, subacromial decompression leaving the acromiocoracoid ligament intact & resection of distl clavicle of right shoulder.
A posterior portal was used for insertion of a 4mm 25 degree arthroscope which infused Ringer's lactate , the rotator cuff tear with mass eas easily identified. Using an Arthroscope bipolar radiofrequency wand, the capsule was taken off the superior glenoid and a release was made the subscapularis rotator cuff interval. Once this was accomplished the under surfaced of the acromion was debrided with a shaver. The arthroscope was then placed in the subacromial space and adhesions were removed from anterior to posterior from medial to lateral of the rotator cuff until the rotator cuff along with the biceps tendon was able to be pulled to the edge of the greater tuberosity. A burr was used to decorticate at the articular magin. A wide surface for biological healing of the rotator cuff. Once this was accomplished, through anterior superior portal, a posterior medial hole was tapped for a swivel lock anchor. An 8mm cannular was placed in the lateral portal and a suture lock anchor with fibertape was inserted into the hole at a slight angle until it was inserted completely. The inserter was removed. The fibertape was pulled and there was good fixation. Using a banana suture passer through the neviaser portal, the needle was placed through the medial rotator cuff out through the tear and the wire was pulled out through the lateral cannula. The fibertape was retrieved through the lateral cannula placed through the loop and pulled out through the port of neviaser. This was repeated with an anterior medial swivel lock anchor and terefore, there were two anchors in place. Once this was accomplikshed, a posterolateral hole was made along the greater tuberosity. One limb from each anchor was pulled through the cannula and threaded through the swivel lock anchor and was then inserted posteriorly pulling the sutures taut while inserting the anchor pulling the rotator cuff over the greater tuberosity with the excellent fixation. Once this was tightened using a fiberwire cutter both limbs were cut. This was performed on the anterior taking the two remaining sutures placing it through the lateral portal and the anchor through the previous hole that was anterior inserting it, tightening it, removing the inserter and cutting the fiberwire separately a speed bridge was obtained with excellent fixation and a watertight seal. One of the sutures had passed through the biceps tendon perofrming a biceps tenodesis. The distal clavicle was resected to an amount of 9mm and a widely debridement of the acromion leaving the acromiocoracoid ligament intact.
SuperCoder Answered Wed 19th of May, 2010 07:48:33 AM
As per the Op report you can report only 29827, 29824 and 29826. CPT 29825 gets bundled with these codes. As far as CPT 29828 I think it is not coded because there is no enough document to support this code, generally this procedure is performed by releasing the biceps tendon from the top of the shoulder and fixing it in the bicepital groove, usually with a interference screw.
Annette Posted Wed 19th of May, 2010 16:28:17 PM
"the rotator cuff along with the biceps tendon was able to be pulled to the edge of the greater tuberosity", & "Once this was tightened using a fiberwire cutter both limbs were cut" "One of the sutures had passed through the biceps tendon perofrming a biceps tenodesis"
The above phrases are what confused me, because it does seem like he did do something with the biceps tendon, released it & moved it elsewhere with an anchor
SuperCoder Answered Thu 20th of May, 2010 07:33:42 AM
Even that part did confuse me, too. Though there is not enough documentation for 29828, still the doc. has mentioned clearly about "performing a biceps tenodesis". I second Alex. But I also feel that 29828 can also be tried to bill, apart from coding 29824, 29826, 29827. Modifier 59 is not necessary with any of the codes, but modifier 51 (with 29824, 29826 & 29828) can be, based on the payer.
Annette Posted Thu 20th of May, 2010 12:44:13 PM
Just to be clear. So then just not 29825 right?
By the way... thanks always to both of you, for your help
SuperCoder Answered Thu 20th of May, 2010 13:56:20 PM