# Arthroscopic shoulder coding specialists help please



## MMadrigal (Sep 10, 2011)

I am wanting to bill 29827 Rotator Cuff Repair, 29806 Bankart repair and 29819 rem loose body, but I don't know about -59 vs -51 and possible mod-22 because of the note at the end of the op report.   The only ICD provided was 831.00   Thank you in advance for any suggestions/thoughts. Mary

"The standard posterior portal was established, penetrating through the posterior deltoid wtih a sharp trocar & then through the posterior capsule with a blunt trocar.  The 30Dyonics scope was placed into the posterior portal."  ....flushed of blood, fluid debris, landmarks inspected...

"Using an inside out technique & with a switching stick an anterior portal was then created  A cannula was then brought anteriorly, & then an arthroscopic shaver was used to effect a synovectomy.  An Arthrex screw-in cannula was placed anteriorly under direct vision.  A superior portal was established utilizing an 18 guage spinal needle, a number 11 blade & a switching stick.  The scope was placed in the superior portal, and a second Arthrex screw in cannula was placed poteriorly.  

There was a loose previously placed suture metallic anchor in the posterior aspect of the humneral head.  this was removed arthroscopically.  The arthroscope then placed superiorly and we were able to discover that he had a very classic Bankart lesion that had healed and obviously torn again, 3 suture anchors that were exposed with torn sutures, 50% of the Bankart/labral lesion that was healed and 50% retorn.  Opted to proceed with the 3rd Bankart repair arthroscopically, creating an anatomic repir.  

The Bankart lesion was developed using a small whisker blade, arthroscopic elevator and probe.  Holes then made at the junction of the glenoid neck & articular cartilage, starting with the Mitek T-handled awl, followed by the Mitek drill.  Holes marked wtih a small basket.

The capsulolabral complex was then repaired to the anterior aspect of the glenoid neck using number 1 Fibrewire suture; a Spectrum suture hook placed through the capsulolabral complex & was used to pass a Concept suture shuttle.  Suture shuttle was then retrieved posteriorly, loaded with #1 Fibrewire suture and then was then retrieved back anteriorly.  Care taken to insure no tangles & Generation 2Mitek suture anchor was placed into the most inferior hole.  Modified sliding loop with 4 alternanting half hitches were used to secure the repair.  Same proc was repeated unti the capsulolabral complex was securely repaired. 

The large posterior Hill-Sachs lesion, opted for soft tissue repair, the inferior aspect of the infraspinatus was brought to the posterior Hill-Sachs lesion using rotator cuff suture anchor in a simial techniqaue as used to prepare the Bankart lesion.  In order to tighten the anchor, the traction was removed.  This made it technically difficult & placed a second anchor.

This was a 3rd revision Bankart repair, technically very difficult, it is at least a 200% degree of difficulty of primary open versus arthroscopic Bankart repair, combined with the reemplissage procedure. "


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## astephens (Sep 10, 2011)

29807 and 29806-59


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## MMadrigal (Sep 11, 2011)

Thank you Angelica.  I will drop the rotator cuff repair, and use the 29807, but should I append a modifier -22 to either code, because of docs note re 200% increase in difficulty?  Mary  mmadrigal@hawaii.rr.com


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