Wiki Open subscapularis tendon and rotator cuff repair

[cwilson3333]

Not sure if I am coding these procedures correctly

Operation Performed: Arthroscopy, Labral Debridement, Subacromial Decompression with Open Repair of Subscapularis Tendon, Biceps Tenodesis, and rotator cuff repair, right shoulder

Post operative diagnosis: Full Tear of subscapularis tendon with avulsion, dislocation biceps tendon with a 2.5 cm tear rotator cuff, and impingement syndrome

CPT 23412 [Subscapularis and Rotator Cuff]
CPT 23430 [Biceps Tenodesis]
CPT 29823 [Labral Debridement]
CPT 29826 [Subacromial Decompression]

After the scope procedures, a 4-cm incision was made between the anterior and lateral portals, Subscapularis was completely avulsed, Bed of bone prepared and fixed in 2 row technique. Prior to this biceps tenodesis was done with Arthrex biceps tenodesis Tightrope. Subscapularis was reapproximated with 2 Corkscrew anchors, double armed mattress stitches to take it to the soft tissue fibers which were anterior portion of greater tuberosity. Rotator cuff tear was identified. Bed of bone had been prepared. It was freshened. It was fixed in a 2-row technique. The medial row was 2 corkscrew anchors, double-armed mattress stitches and then 1 Swivelock which gave a watertight closure...…………………………

Our doctors are doing a lot of subscapularis tendon repairs and not sure about coding this tendon separately since it is the rotator cuff

 

[meghanhannus]

Hello cwilson3333,

The technique your provider is using is referred to sometimes as a "mini open". I agree with your codes and would not code the subscapularis tendon repair separately as the subscapularis tendon is part of the rotator cuff. The repair is considered an inclusive component of the procedure.


Hope this helps~

M.Hannus, CPC, CPMA, CRC

 

[Orthocoderpgu]

I would question code 29823

Code 29823 is extensive debridement. Most of the time you are not going to meet that with just labral debridement.

Keep in mind that any restorative procedure will start with debridement, such as debriding the rotator cuff tendons before the repair, and is not included with 29822 or 29823.

29822 can only be billed on its own.

Without looking at the entire op, and from what information you have posted I doubt 29823 is supported.

 

[cwilson3333]

Hello cwilson3333,

The technique your provider is using is referred to sometimes as a "mini open". I agree with your codes and would not code the subscapularis tendon repair separately as the subscapularis tendon is part of the rotator cuff. The repair is considered an inclusive component of the procedure.


Hope this helps~

M.Hannus, CPC, CPMA, CRC

Thank you for taking time to reply. I am familiar with coding mini-open procedure, just wasn't sure about the subscapularis, since the doctors seem to be dictating that as a separate procedure here lately.

 

[cwilson3333]

Code 29823 is extensive debridement. Most of the time you are not going to meet that with just labral debridement.

Keep in mind that any restorative procedure will start with debridement, such as debriding the rotator cuff tendons before the repair, and is not included with 29822 or 29823.

29822 can only be billed on its own.

Without looking at the entire op, and from what information you have posted I doubt 29823 is supported.

So if I cannot bill the 29823, I can't bill the 29826. I should bill the 29822, which would cover the debridement and the decompression, is that correct?

Shoulders and ankles are the hardest to bill, I think.