Can you please explain what codes should be used? I appreciate any help with this.
Are you working in the capacity of the coder or in accounts receivable/denial capacity? Point being, who is coding your operative reports, the provider? Do you have certified coders? Joining AAPC for this is great however, I would also highly recommend AAOS or
https://karenzupko.com/
I like to see the reasoning and info behind why the codes were chosen in this case. If you coded this one, what led to the code choices? 23420 is used for reconstruction of massive tears with extensive work. If you read the code it says reconstrucion of complete shoulder (rotator cuff) avulsion, chronic (includes acromioplasty). Not used for mini-open rotator cuff repair, even if a bio-implant was used. I would direct you to 23412. After re-reading report, I agree 29823 "may" be ok in this case.
In this op note I see 23412 & 29823:
labral debridement, biceps tenotomy, anterior synovitis debrided via scope (29822) (See below)
SAD via scope (29826). Depending on payer may or may not be allowed with open RCR. Also, documentation is not the best for 29826 in report. So, would add to the work for 29822 and probably report 29823 (labrum, biceps, synovitis, spur, bursal tissue)
mini open RCR w/ (prep) debridement of the supra and infraspinatus (included) w/ bio-implant patch (23412)
Bundling, NCCI edits and guidelines come into play if payer follows CMS.
Some references.
Very important:
https://www.cms.gov/files/document/medicare-ncci-policy-manual-2023-chapter-4.pdf
See Section E. Arthroscopy (really the whole chapter)
http://www.ccmpro.com/files/40500676.pdf (old but concepts apply however significant changes to 29822, 29823 codes so don't go by the actual code info just concepts)
"The American Academy of Orthopaedic Surgeons reiterates that you shouldn’t use CPT 23420 simply for a repair of a massive tear but for a reconstruction of a massive tear with significant retraction that involves extensive releases and mobilization, as well as fascial or synthetic material when applicable, in order to return the tendon to its original anatomical location. In other words, we aren’t simply suturing and repairing a tendon via anchors and tacks. In addition, three tendons need not be torn to support reporting CPT 23420."
Ortho provider need these:
https://www5.aaos.org/store/product/?productId=20089615&ssopc=1
29822 vs. 29823 CPT language:
CPT 29822 — Arthroscopy, shoulder, surgical; debridement,
limited, 1 or 2 discrete structures (e.g., humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body[ies])
CPT 29823 — Arthroscopy, shoulder, surgical; debridement,
extensive, 3 or more discrete structures (e.g., humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body[ies])