rvargas1976
New
The doctor coded 29823, 23120 [51], 29826. Health plan will not reimburse CPT 29826. Can some one assits on how i should be billing?
DESCRIPTION OF THE PROCEDURE: The patient was identified in the preoperative holding area and the right upper extremity was marked. A regional block was placed by the Anesthesia Service. She was then brought to the operating room where general anesthesia was induced. The right upper extremity was prepped and draped in the usual sterile fashion. A surgical time-out was performed to confirm the right upper extremity as the correct operative extremity. The patient received 1 g of Ancef intravenously prior to the time of surgical start.
A standard posterior arthroscopic portal incision was created and a diagnostic arthroscopy was performed. This demonstrated spontaneous rupture of the proximal biceps tendon with approximately a 2 cm segment still attached to the superior labral attachment. Remainder of the biceps tendon was not visualized. The superior labrum and anterior labrum demonstrated substantial degenerative fraying. The posterior labrum was normal in appearance. The articular cartilage of the glenoid and humerus demonstrated no substantial degenerative changes. The subscapularis demonstrated a partial thickness tear of its superior fibers. The undersurface of the rotator cuff demonstrated significant disorganization consistent with probable full-thickness rupture. However, this was difficult to visualize initially.
An anterior portal was established via spinal needle localization. This allowed placement of an articular shaver and electrocautery wand. These were used to debride the biceps tendon stump, the superior labrum and anterior labrum, the subscapularis was also gently dthrided and the majority of the tendon was seen to be still intact at its insertion; therefore, no repair was necessary. The undersurface of the rotator cuff was then debrided and full-thickness defect was confirmed. Once this thorough debridement had been undertaken, the arthroscopic equipment was redirected into the subacromial space. A dense bursitis was encountered, which was resected through an established lateral portal using the articular shaver and electrocautery wand. This exposed a moderate sized subacromial spur, which was resected using a 4-mm barrel bur to achieve wide decompression of the subacromial space. The superior aspect of the rotator cuff was then inspected and the previously mentioned full-thickness defect was identified. The articular shaver was used freshen the tendon edges as well as debride the footprint to achieve a good bony bed for healing repair. Once this had been completed and accessory portal was created using a spinal needle to allow placement of a 5.5 mm Bio-Corkscrew device. This was deployed in the standard fashion and then the doubly loaded high tensile suture was shuttled through the tendon in a modified Mason-Allen configuration.
The sutures were then tensioned and tied providing excellent closure of the rotator cuff defect and a tension free repair.
Once this was completed, all arthroscopic equipment was removed from the shoulder joint. Excess fluid was drained. Attention was turned towards the open Mumford procedure. A small transverse incision was created over the distal aspect of the clavicle and taken down through the subcutaneous tissues by blunt dissection. The underlying trapezial fascia was then longitudinally divided to expose the underlying clavicle. Subperiosteal elevation was performed. The distal 1 cm of the clavicle was then resected using an oscillating saw. No sharp bony contours were left behind and adequate wide decompression of the acromioclavicular space had been achieved. The wound was copiously irrigated with sterile saline and bacitracin. The deep fascia was closed with 0-Vicryl suture, followed by 2-0 Vicryl closure of the subcutaneous tissue, and 3-0 Monocryl closure of the skin and portal sites. Sterile dressings were applied including Steri-Strips, 4x8 gauze, ABD pad, and Medipore tape.
DESCRIPTION OF THE PROCEDURE: The patient was identified in the preoperative holding area and the right upper extremity was marked. A regional block was placed by the Anesthesia Service. She was then brought to the operating room where general anesthesia was induced. The right upper extremity was prepped and draped in the usual sterile fashion. A surgical time-out was performed to confirm the right upper extremity as the correct operative extremity. The patient received 1 g of Ancef intravenously prior to the time of surgical start.
A standard posterior arthroscopic portal incision was created and a diagnostic arthroscopy was performed. This demonstrated spontaneous rupture of the proximal biceps tendon with approximately a 2 cm segment still attached to the superior labral attachment. Remainder of the biceps tendon was not visualized. The superior labrum and anterior labrum demonstrated substantial degenerative fraying. The posterior labrum was normal in appearance. The articular cartilage of the glenoid and humerus demonstrated no substantial degenerative changes. The subscapularis demonstrated a partial thickness tear of its superior fibers. The undersurface of the rotator cuff demonstrated significant disorganization consistent with probable full-thickness rupture. However, this was difficult to visualize initially.
An anterior portal was established via spinal needle localization. This allowed placement of an articular shaver and electrocautery wand. These were used to debride the biceps tendon stump, the superior labrum and anterior labrum, the subscapularis was also gently dthrided and the majority of the tendon was seen to be still intact at its insertion; therefore, no repair was necessary. The undersurface of the rotator cuff was then debrided and full-thickness defect was confirmed. Once this thorough debridement had been undertaken, the arthroscopic equipment was redirected into the subacromial space. A dense bursitis was encountered, which was resected through an established lateral portal using the articular shaver and electrocautery wand. This exposed a moderate sized subacromial spur, which was resected using a 4-mm barrel bur to achieve wide decompression of the subacromial space. The superior aspect of the rotator cuff was then inspected and the previously mentioned full-thickness defect was identified. The articular shaver was used freshen the tendon edges as well as debride the footprint to achieve a good bony bed for healing repair. Once this had been completed and accessory portal was created using a spinal needle to allow placement of a 5.5 mm Bio-Corkscrew device. This was deployed in the standard fashion and then the doubly loaded high tensile suture was shuttled through the tendon in a modified Mason-Allen configuration.
The sutures were then tensioned and tied providing excellent closure of the rotator cuff defect and a tension free repair.
Once this was completed, all arthroscopic equipment was removed from the shoulder joint. Excess fluid was drained. Attention was turned towards the open Mumford procedure. A small transverse incision was created over the distal aspect of the clavicle and taken down through the subcutaneous tissues by blunt dissection. The underlying trapezial fascia was then longitudinally divided to expose the underlying clavicle. Subperiosteal elevation was performed. The distal 1 cm of the clavicle was then resected using an oscillating saw. No sharp bony contours were left behind and adequate wide decompression of the acromioclavicular space had been achieved. The wound was copiously irrigated with sterile saline and bacitracin. The deep fascia was closed with 0-Vicryl suture, followed by 2-0 Vicryl closure of the subcutaneous tissue, and 3-0 Monocryl closure of the skin and portal sites. Sterile dressings were applied including Steri-Strips, 4x8 gauze, ABD pad, and Medipore tape.