# Shoulder surgery - I am in the middle



## Desperate Denise (Oct 31, 2009)

I am in the middle of a Blue Shield audit so I am looking for support from my colleagues to be sure I can respond with confidence and since my docs are going crazy - I would appreciate some help from colleagues.  

PROCEDURE 1:

DX:  Chronic rotator cuff tear which was deemed irreparable
       Biceps tendon fraying greater than 50%
       Left shoulder pain

PROC:    Arthroscopic subacromial decompression
                              coplaning distal clavicle
                              biceps tenotomy
                              shoulder debridement

In the body of the operative report doc reports Grade I chondromalacial changes over the gelnoumeral surfaces, distal calvicle spur impinging on the rotator cuff.  According to op note the only thing done to the rotator cuff was "extensive mobilization under tension"    

Any ideas would be appreciated.  I used 29828 (no arthroscopic tenotomy), 29824-59, 29826-59??????


The second one is:

DX:   Impingement syndrome and Type II SLAP

PROC:  Chondroplasty of the glenohumeral, repair SLAP, subacromial decompression

I coded: 29807, 29826-59 and 29822-59     ANY IDEAS

Sorry for all these shoulder things - I need some confidence and obviously a coding course - a lot has changed since last year.

Thank you from the bottom of my heart - not sure I would look good in an orange jump suit.


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## JMeggett (Nov 2, 2009)

_PROCEDURE 1:

DX: Chronic rotator cuff tear which was deemed irreparable
Biceps tendon fraying greater than 50%
Left shoulder pain

PROC: Arthroscopic subacromial decompression
coplaning distal clavicle
biceps tenotomy
shoulder debridement

In the body of the operative report doc reports Grade I chondromalacial changes over the gelnoumeral surfaces, distal calvicle spur impinging on the rotator cuff. According to op note the only thing done to the rotator cuff was "extensive mobilization under tension" 

Any ideas would be appreciated. I used 29828 (no arthroscopic tenotomy), 29824-59, 29826-59??????_
I would not bill 29826 unless a partial acromioplasty was also done with the decompression of subacromial space.  29828 is for tenodesis, which is sewing of the biceps tendon. For biceps tenotomy, which is cutting of the tendon, there is no cpt for arthroscopic so unlisted 29999 is needed. AAOS recommends that 29824 only be charged if 1cm or 8-10mm of the clavicle is removed. I have my docs document exactly how much bone is removed just to cover all our back-sides.    Without seeing the whole note is difficult to tell you exactly what should have been coded.
Jenna


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## JMeggett (Nov 2, 2009)

_The second one is:

DX: Impingement syndrome and Type II SLAP

PROC: Chondroplasty of the glenohumeral, repair SLAP, subacromial decompression

I coded: 29807, 29826-59 and 29822-59 ANY IDEAS_

Without seeing note it's difficult to know exactly what was done, but 29807 & 29826 don't bundle and should be ok.  I only code 29826 if BOTH subacromial decompression AND partial acromioplasty are documented. I don't see that -59 is needed on 29826.    29822 is included in 29807 and adding modifier -59 doesn't unbundle in this case.  
Jenna


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## Desperate Denise (Nov 2, 2009)

*Desperate D*

JMegget - thank you for your help and insight.  I do have to get the docs to document in more detail relative to the types of SLAP lesions, the size of loose bodies and the size of the clavicule incisions.  I truly appreciate your help.  This will help me tremendously.  Thanks so much for taking the time to answer - Desperate D


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