# 29827 with 29823?



## MELJNBBRB (Mar 16, 2015)

Hi List needing some guidance 

TIA
MB,CCS,CPC


PREOPERATIVE DIAGNOSES:
Left shoulder bursitis, impingement syndrome, possible tear of
the rotator cuff.

POSTOPERATIVE DIAGNOSES:
Left shoulder bursitis, impingement syndrome with synovitis in
the shoulder joint and tear of the supraspinatus tendon,
726.10726.2, 727.00, 840.4.

PROCEDURE:
Arthroscopic examination with extensor debridement of the
joint and subacromial space with acromioplasty and release of
the coracoacromial ligament with arthroscopic repair of the
rotator cuff, supraspinatus tendon, 29827, 29823-59.

SURGEON:


ANESTHESIA:
General endotracheal.

ESTIMATED BLOOD LOSS:
Minimal.

COMPLICATIONS:
None.

BRIEF CLINICAL HISTORY:
This is a 62-year-old white male with a history of persistent
pain and soreness of his left shoulder.  He had pain off and
on for years and it has gotten gradually worse.  He has had
continued trouble despite conservative care including
injection, medication, and exercises.  He had MRI scan, which
showed bursitis and impingement and possible rotator cuff
tear.  Options of continued conservative care versus surgery
were discussed with him at length.  He requests surgical
treatment.

DESCRIPTION OF PROCEDURE:
After taking informed consent, the patient was brought to the
operating room table in supine position.  After administration
of general endotracheal anesthesia, the patient was placed in
the beach chair position and the left shoulder and arm were
sterilely prepped and draped in routine manner.

Time-out was then performed, the patient was identified,
appropriate body site had been marked, and he received
appropriate antibiotics.

Next, the posterior arthroscopy portal was then made in the
joints, subacromial space infiltrated with saline with
epinephrine.  Next, the arthroscope was placed into the
posterior shoulder joint through the portal and examination of
the joints was performed.  Examination of the inflammation of
the biceps tendon and inflammation of the synovium.  The
labrum shows slight fraying, but no obvious tear was noted.  
Articular surfaces were normal in appearance.  There was noted
to be a tear in anterior portion of the supraspinatus tendon.  
The other tendons were intact.  Next, with the aid of
Wissinger rod, an anterior portal was made and a cannula was
placed anteriorly.  Next with aid of the shaver, inflamed
synovium was debrided as was the frayed portion of the biceps
tendon and underside of the rotator cuff and frayed edges of
the labrum.  The arthroscope was placed anteriorly and then
shaver placed posteriorly to complete the debridement.

Next, the scope was placed back into the posterior portal and
into the subacromial space.  A lateral portal was made and the
cannula was placed in the subacromial space laterally.  Next,
with the aid of shaver, bur, and electrocautery, subacromial
decompression was performed and the acromionizer was used to
perform acromioplasty.  A release of the coracoacromial
ligament also was performed.  An 18-gauge spinal needle was
used to mark the anterior posterior aspect of the AC joint and
anterolateral acromion.  Adequate decompression of the
acromioplasty was felt to be performed.  Thorough debridement
was performed and the rotator cuff tear was again identified.  
This was debrided with a shaver.  The cuff tear was about a cm
in diameter and it was elected to try and repair this
arthroscopically.  Next, with small incision at the
anterolateral edge of acromion, the guide for the placement of
the anchor was placed and the device was used to make an
opening in the bone was tapped down, making an opening in the
lateral side of the articular surface.  Next, through the
lateral portal FiberTape suture was woven through the tendon
and then with the aid of the interference screw, the repair
was tightened down to the anchor and the anchor was advanced
stabilizing the rotator cuff repair.  Good repair was noted.  
It was elected to place a second stitch with aid of the anchor
holding the rotator cuff to the bone.  Good repair was noted.  
Remainder of the exam was otherwise unremarkable.  The repair
was probed and noted to be stable.  Next, the arthroscopy
equipment was removed from the shoulder.  The portals were
closed with interrupted nylon sutures.  He had received a
block in the holding room.  A sterile dressing was applied and
is placed in sling and transferred to the recovery in stable
condition.


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## b_rodgers (May 6, 2015)

Personally, I haven't found a good way to bill a debridement with a repair, insurance companies love to bundle them. Can you bill for the 29826? That makes up for it for us.

Also, I'd use 840.6 for the supraspinatus tear, but that's just me


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## talitha82 (May 14, 2015)

There was an update to Arthroscopic Shoulder cases in CPT changes for 2014. In the "old days" you could code that debridement if it was done in a "separate area"- however, as of 2014, the shoulder is considered one anatomical area, and the debridement is considered bundled into other arthro procedures. You can verify this by reading in the CPT Changes for 2014. However, I agree that you DO have a 29826 there with the subacromial decompression, and you SHOULD use 840.6 as it is more specific for the cuff tear. The patient is older, so this might actually have been a degenerative tear, but as your physician didn't clarify that, you have to use the 840.6 instead. But this does provide you with an opportunity to discuss better documentation with your physician regarding degenerative vs. acute tears. I hope that all helps!


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