# Arthroscopic superior capsular reconstruction



## jasejaxson@gmail.com (Jan 31, 2018)

Hello all, I am working on an appeal and not too familiar with ortho coding. I am getting conflicting information if code 29999 is used to represent Arthroscopic superior capsular reconstruction or does it have a correct code? Thanks


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## AlanPechacek (Jan 31, 2018)

Unfortunately you don't give a lot of detail or information, so I am "assuming/guessing" that this is a shoulder surgery case.  As such, the *"superior capsule"* of the shoulder joint is the *Rotator Cuff*.   To say that it was a *"reconstruction"* indicates that it was a severe/extensive/large/complex and probably chronic tear requiring a lot of hard work to repair it.  Irregardless of the severity and complexity of the tear and its repair, the code for *Arthroscopic Rotator Cuff Repair* is *29827*, assuming it was all done arthroscopically and that was all that was done.
     The Code *29999: Unlisted arthroscopic procedure* is essentially meaningless, and should only be used as a very last resort, and has to be "paired" with a code that most closely matches the procedure done in its complexity. 

I hope this helps you some.

Respectfully submitted, Alan Pechacek, M.D.


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## Orthocoderpgu (Feb 1, 2018)

*Question for Dr. Pechacek MD*

Thanks for your response, that really clears things up. 

It sounds like a "Superior Capsule Reconstruction" is basically taking the place of the supraspinatus if you will.

It seems to me like the supraspinatus is not repairable, so the graft that is anchored more or less takes its place and helps keep the humeral head in the socket.


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## AlanPechacek (Feb 1, 2018)

You now mention the use of a *graft* in this procedure to repair/reconstruct the Rotator Cuff.  You are correct in that if a graft was placed, it was either used to supplement/reinforce the repair (if it could be completed/repaired back to bone), *or* it was used to "fill in and bridge the gap" between the lateral edge of the cuff (that could not be advanced laterally so it could be repaired to the humerus/tuberosity) and the tuberosity thus allowing for it to be repaired to bone.  This also "closes the gap" so to speak in the cuff.  In that respect, this was a *"Reconstruction" of the Rotator Cuff* for an extensive chronic tear.  Unfortunately, even though the surgeon was able to do this arthroscopically, the arthroscopic code for *Rotator Cuff Repair (29827)* is grossly inadequate for the amount of work done to do this procedure.  This code is for the more simple and less complicated repairs, not necessarily for "reconstructions" like this appears to have been.  In that respect, an *Unlisted arthroscopy code: 29999* paired to 
*23420: Reconstruction of complete shoulder (cuff) avulsion, chronic *might be a better option.

I hope this helps too/more now that you have given more information.

Sincerely, Alan Pechacek, M.D.


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## donsgirl1015 (Feb 26, 2018)

*cpt for superior capsular reconstruction (scope procedure)*

I'd like to throw my OP report in the ring for some coding guidance please ~
the dx I have is "right shoulder irreparable superior  rotator cuff"

procedure: 
...you see he had a superior labral tear that was retracted back to the level of the glenoid.  it was immobile.  it was not repairable. he had a good infraspinatus. we went ahead and decided to proceed with the superior capsular reconstruction. we decorticated over the superior glenoid and placed 2 anchors at 2 o'clock and 10 o'clock position. placed our 2 medial row anchors as well. used our measuring guide for anterior-posterior distance. we cut our graft appropriately and passed our sutures through the graft, outside of the shoulder. graft was passed into the shoulder and secured. ....we tied the other 2 sutures over the glenoid as well and got good repair.  brought sutures and did double row repair, did 2 lateral rows. placed 2 fiberlinks as well to pull graft down. placed 2 side to side stitches from infraspinatus to the graft. brought sutures from the glenoid through supraspinatus to help with vascularization. sutures were cut, instruments were removed.......


I feel like there are some puzzle pieces missing, but the info I find on coding the reconstruction lead me to 29806-22.

any help, guidance or leading questions to take back to the provider would be greatly appreciated.

thank you,
melissa


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## along06 (Mar 1, 2018)

*Question about SCR reimbursement*

Have you tried billing the SCR 29999 with 23420?  Have both been reimbursed?


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## daedolos (Mar 1, 2018)

along06 said:


> Have you tried billing the SCR 29999 with 23420?  Have both been reimbursed?


How is that billed on the CMS 1500?  Is line 1 29999 with a dollar amount then line 2 = 23420?

Peace
?_?
Just curious as I am not sure how to actually implement unlisted procedures on the billing side. Any advice or links would be much appreciated.


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## shecodes (Mar 6, 2018)

I think, and please correct me if I am wrong, what Dr. Pechacek meant by 29999 "paired to" 23420, is to use 23420 as the comparison code for the 29999. This would be one line of billing for the ASCR. 

It's worth noting as well, that there is a CPT Assistant from April 2017 that states the appropriate code choice is 29999 for the ASCR.


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