# Posterior AND Anterior AND Slap Repair



## Sara82 (Mar 2, 2011)

29806 - Anterior 
29806/59 - Posterior 
29807/59 - SLAP 
29826/59 - Sub Decompression 
29823/59 - Debridement 

The above codes are what Im getting from the report. Ive never billed for so many labral repairs together, and wanted to see if any other coders that had more experience with shoulders could give me a thumbs up ont he above codes or advice in how to correctly bill for these. 
And also what ICD 9 Code I would use for the Anterior & Posterior Labral Tears. Any help is appriciated! Thanks! 


OPERATION PERFORMED: 
Left shoulder arthroscopy with extensive glenohumeral joint 
debridement, posterior labral repair, anterior labral repair, and 
superior labral anteroposterior repair. We also did a 
subacromial decompression. 


A probe was inserted. Diagnostic arthroscopy was performed. 
There was significant tear of the anterior, superior, and 
posterior labrums. These were identified with a probe. The 
anterior labrum was torn completely from the 7 o'clock position 
superiorly incorporating the superior labrum. There was 
disruption of the biceps tendon that was continuous with the 
superior anterior aspect of the labrum that extended up into the 
biceps tendon. The superior labrum was also torn completely with 
a type 2 SLAP. This extended posteriorly to the posterior labral 
tear that extended posteriorly to the approximate 4 o'clock 
position. There was significant debris throughout the 
glenohumeral joint. This was debrided using the 4.5 shaver. 
There was significant fraying throughout this labral tissue. It 
was all debrided using the 4.5 shaver. There was synovitis 
throughout the posterior and superior aspects of the capsule. It 
was all debrided using the 4.5 shaver. There were no loose 
bodies in the axillary pouch. The articular surfaces of both the 
humeral head and glenoid showed some grade 2 chondral change. 
There was a significant Hill-Sachs deformity noted. The 
undersurface of the rotator cuff was intact. Attention was first 
directed towards the posterior labrum. The scope was placed in 
the anterior portal and the elevator was placed in the posterior 
portal. The posterior labral tear was then elevated. Once 
adequate elevation was achieved, the tissue was appropriately 
mobilized. A rasp was then used to rough up the bone as well as 
the labral tissue. 2 JuggerKnot anchors were then placed over 
the posterior glenoid. These anchors were then used to secure 
the labral tissue to the prepared glenoid rim. Once this was 
complete, the tails were appropriately cut, arthroscopic 
instruments were then removed and the arthroscope was then placed 
in the posterior portal and attention was directed towards the 
anterior labrum. 2 JuggerKnot anchors were then placed 
inferiorly in the glenoid. Each of these anchors were then used 
to secure inferior capsular and labral tissue to the anterior 
inferior aspect of the glenoid. Then three 3.0 mm Bio-SutureTak 
anchors were then placed over the middle and anterior superior 
aspect of the glenoid. The capsular and labral tissue was then 
repaired to the glenoid. Once these knots were tied, and tails 
were appropriately cut, attention was then directed to the SLAP 
tear. The arthroscope was placed in the posterior portal. A 
trans tendinous portal was established using a spinal needle and 
a knife used to dissect through the skin and subcutaneous tissue. 
A sharp trocar was then used to place two 3.0 mm Bio-SutureTak 
anchors in both the anterior and posterior aspects of the biceps 
insertion on the superior glenoid. These were then passed around 
the labral tissue and tied sequentially. Care was taken to 
ensure appropriate reduction of the biceps anchor to the superior 
aspect of the glenoid. Once this was complete and appropriate 
tails were cut, the labral repair circumferentially was inspected 
and felt to be appropriate. Once this was complete, the 
glenohumeral joint was then copiously irrigated with normal 
saline. A spinal needle was used to place a PDS suture through 
the lateral edge of the rotator cuff. It was managed to the 
anterior portal. All the instruments were then removed from the 
glenohumeral joint and a trocar was used to redirect the cannula 
into the subacromial space. Once in the subacromial space 
through the posterior portal, a spinal needle was used to 
identify the location of the lateral portal. Once this lateral 
portal position was identified, a trocar was used to dilate the 
portal. A 5.5 shaver was then introduced. A subacromial 
decompression was performed and all bleeding points were stopped 
with electrocautery. Once this was complete, ArthroCare was used 
to resect the soft tissues on the undersurface of the acromion 
including the coracoacromial ligament. Once this was complete, a 
significant subacromial spur was noted. A 5.5 bone-cutting 
shaver was then used to perform an acromioplasty. Once this 
acromioplasty was complete, the resection was inspected and felt 
to be appropriate. All bony debris was then removed from the 
subacromial space.


----------



## raemitch78 (Mar 3, 2011)

You can only bill 29806 once.  I have looked at the same scenerio over and over because my physician wants to bill it out twice.  There is only one capsule in the shoulder therefore, it can be charged only once.  I found this in the AAOS bulletin Aug 03 - it is also qouted on this list serve.  Hope that helps... 

Rachel CPC, CPC-H


----------



## Sara82 (Mar 4, 2011)

Yes it does help! Thanks so much!


----------

