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codegirl0422

codegirl0422

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I am having a problem coming up with the right code for a biceps tenotomy.

PROCEDURE PERFORMED:
1. Diagnostic and surgical arthroscopy left shoulder with arthroscopic rotator cuff repair.
2. Left shoulder arthroscopic biceps tenotomy.

I have seen some say to code as unlisted 29999. also seen saying using 29822 or 29823, that it is considered part of a debridement service. I have been suggested to use 23405 but I am not sure that is right either.

Any help on this would be greatly appreciated.

Thanks
 
Orthopedic Coding Alert


You Be the Coder: You Can Bill Together For Tenotomy and Debridement

Question: Is it true that we cannot bill 23405 (Tenotomy, shoulder area; single tendon) with 29822 (Arthroscopy, shoulder, surgical; debridement, limited) unless it's a revision or a reconstruction.

Our surgeon did the following procedures:
•Right shoulder arthroscopy with intraarticular debridement
•Debridement of portion of the inferior labrum
•Anterior labral repair
•Superior labral repair
•Rotator cuff repair
•Subromial decompression with acromioplasty

The operative note also states:

"A biceps tenotomy was performed, as the biceps had a tendency to come in and out of the bicipital groove. Using 2 corkscrews and 4 sutures, the rotator cuff was repaired back to its insertion on the humerus." Do we report this with 23405?

Pennsylvania Subscriber

Answer: The correct code for biceps tenotomy is 23440 (Resection or transplantation of long tendon of biceps). You may report 23440 instead of 23405. You can report this with 29822. Tenotomy and debridement do not bundle with each other. You will report codes 29806 (Arthroscopy, shoulder, surgical; capsulorrhaphy) LT, 23412 (Repair of ruptured musculotendinous cuff [e.g., rotator cuff] open; chronic) -59 (Distinct procedural service.....), 29822 -59, +29826 (Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament [i.e. arch] release , when performed [List separately in addition to code for primary procedure]) -59. However, it is not clear if any of these procedures were performed open rather than arthroscopically. If your surgeon did the rotator cuff repair arthroscopically, you report 29827 (Arthroscopy, shoulder, surgical; with rotator cuff repair) rather than 23412. Similarly, if the biceps tenotomy was done arthroscopically, you will consider this inclusive in debridement and report codes 29823 (Arthroscopy, shoulder, surgical; debridement, extensive) or 29822 depending upon the extent of debridement.
 
The Orthopaedic Coding Coach 2013 Archives
Biceps Tenotomy and SAD
February 7, 2013

Question:
Our surgeon performed and documented an arthroscopic biceps tenotomy and arthroscopic subacromial bursectomy. I read in a journal recently that the tenotomy should be reported with an unlisted code and I do not think that is right. We value the advice we receive from Mary LeGrand and Margi Maley and was wondering if they might be able to help us.


Answer:
Thanks for your comments and support of KZA! You are correct to question the advice you read as it is incorrect. An arthroscopic biceps tenotomy is not reported with an unlisted code; it is considered part of a debridement service reported with CPT code 29822 or 29823 depending on the extent of work. An arthroscopic subacromial bursectomy is not reported with CPT code 29826 but is again reported as a debridement service. Two debridement codes cannot be reported for the same surgical session, so report either 29823 or 29822 for the service encompassing the tenotomy and the bursectomy based on the surgeon's documentation
 
is an arthroscopic biceps tenotomy inclusive to extensive debridement

We were just told by our State Labor and Industries review department for prior authorization (Qualis) that per AAPC Coding guidelines, and arthroscopic biceps tenotomy (CPT 29999 compared to 23405) is inclusive to an arthroscopic debridement (29823), however, according to AAOS, these are not inclusive codes as well as looking at the NCCI guidelines Ch 4 section E subsection 7 -

7. Shoulder arthroscopy procedures include limited debridement (e.g., CPT code 29822) even if the limited debridement is performed in a different area of the same shoulder than the other procedure. With three exceptions, shoulder arthroscopy procedures include extensive debridement (e.g., CPT code 29823) even if the extensive debridement is performed in a different area of the same shoulder than the other procedure. CPT codes 29824 (arthroscopic claviculectomy including distal articular surface), 29827 (arthroscopic rotator cuff repair), and 29828 (biceps tenodesis) may be reported separately with CPT code 29823 if the extensive debridement is performed in a different area of the same shoulder.

There were 2 separate arthroscopic portals made one was posterior and then once tenotomy was complete scope was removed and an lateral acromial anterior portal was made.

Can someone tell me where this guidelines is... as I now have conflicting information.

Thank you in advance!!!!
 
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