Wiki Help! Shoulder scope

[ortho1991]

Hi All,

Dr. want to bill 29828,29824,29826,29825/59,29823,29819/59.

Here is the op-note


INDICATIONS FOR PROCEDURE:
is an otherwise active patient who reports significant symptoms
of shoulder pain, which have been refractory to conservative management.
After a failed trial of conservative treatment and with a thorough discussion of
the risks and benefits of operative versus nonoperative treatment, the patient
elected to proceed with the above surgery. Please see my full office notes for
further details.



ARTHROSCOPIC FINDINGS:
Severe global adhesive capsulitis. There is biceps tendinopathy with a SLAP
tear. There were no rotator cuff tears. There was AC arthrosis. There was
impingement, as well as significant scar tissue in the subacromial space. There
was loose body, measured approximately 1 cm in the subacromial space.


EXTENSIVE DEBRIDEMENT:
With the oscillating shaver, synovitis was debrided. Capsular thickening was
debrided. Labral fraying was debrided. Chondromalacia was debrided.

ARTHROSCOPIC LYSIS OF ADHESIONS:
The rotator interval was released from the subscapularis, up to the
supraspinatus. The middle glenohumeral ligament was released, as well as the
anterior band of the inferior glenohumeral ligament. The release was carried
down to the 5 o'clock position and then stopped. Switching stick was used and
the camera was then placed in the anterior portal. Posteriorly, a release was
performed from the 11 o'clock position, down to the 7 o'clock position. No
release was performed in the deep axillary pouch, so as to protect the axillary
nerve. The shoulder was then brought through a range of motion and full motion
was restored.

ARTHROSCOPIC BICEPS TENODESIS:
A spinal needle was used to pass two PDS sutures, which were then used to
shuttle two #2 Orthocords in a locking crossing configuration that surrounded
the tendon like a Chinese finger trap. The tendon was released from the
superior labrum, which was debrided. The sutures were then retrieved in the
subacromial space and tied.

SUBACROMIAL DECOMPRESSION WITH ACROMIOPLASTY:
The instruments were then removed from the glenohumeral joint and placed in the
subacromial space, a separate compartment. With the combination of the
oscillating shaver and the ArthroCare wand, a thorough subacromial bursectomy
was performed. The CA ligament was released from the anterolateral acromion.
With a motorized burr, an acromioplasty was performed. The camera was then
placed in the lateral portal and the instrument in the posterior portal. A
cutting block technique was then used to confirm a smooth even resection.



DISTAL CLAVICLE EXCISION:
The soft tissues with the acromioclavicular joint were resected, taking care to
preserve the capsule anteriorly, posteriorly, and superiorly. With a motorized
burr, a distal clavicle resection was performed. The camera was then placed in
the anterior portal to confirm a smooth even resection. After resection, a
total of 1 cm of acromioclavicular joint space was achieved.

LOOSE BODY REMOVAL:
The loose body was removed with the arthroscopic grasper. This measured
approximately 10 to 11 mm in greatest diameter and it was removed from a
separate compartment from where the other work was done. It was removed
through an accessory portal.


I'm not sure we should bill the 29825/59 any guidance or advice will be very much appriecated.

 

[OCD_coder]

The Op Report does not indicate the laterality of the procedures, so the reader is to assume the work is all performed in a single shoulder joint. I don't have 3M here at home to double check bundling issues. But if 29825 and 29819 bundle to any other procedure as you are indicating with mod-59, per the new MCR NCCI edits and payors that follow these guidelines; are not a billable service for this patient.

The rule of the day now is, never use mod-59 for shoulder procedures unless it's on the contralateral shoulder.