Wiki Please help with shoulder sgy

[BFAITHFUL]

2. DX: adhesive capsulitis, partial tear of the RC and impingement
syndrome plus osteoarthritis of distal clavicle. 726.0, (726.19 or
840.4), 726.2 & 715.31

Procedure:
A posterior portal used and under direct visualization with 18 gauge
spinal needle through extensive scar tissue, where the glenoid was
unable to be visualized but repressing of the subscapular tendon, an
18 gauge spinal needle was identified and dilated to an 8mm cannula.
once this was accomplished the beginning of the lysis of adhesions of
the rotator cuff subscapularis interval between the capsule and the
labrum anteriorly, superiorly and posteriorly. Prior to this, the
patient was manipulated to full forward flexion, abduction and an
external rotation. Once this was accomplished a curved shaver was
introduced to debride the partial rotator cuff tear at the insertion
of the supraspinatus. Once this was accomplished the arthroscope was
redirected into the subacromial space, which again was scarred in with
adhesive scarring of the bursa. This was debrided with a bipolar
radiofrequency wand. blood vessels were electrocauterized with the
bipolar radiofrequency wand an dsoft tissue was removed from bursa.
Subacromial space and the acromiocoracoid ligament were resected.
Soft tissue ws removed from the distal clavicle which revealed
osteoarthritis and 8mm resected, and the arthroscope was then shifted
to the lateral portall through the posterior portal an anterior
acromioplasty was performed and resection of the distal clavicle was
performed with unsheate burr and the tear of the rotator cuff that was
partial was sutured from anterior to posterior through the cannula
with a 45 degree suture passer and a #1 prolene suture. It was
retrieved from the posterior portal through the anterior cannula and a
knot pusher was placed on both sides.

Also Would I use 726.0 for intraarticular adhesions? & 726.2 for
shoulder impingement/RC impingement . I heard somewhere that 726.2
should be used for shoulder impingement but for RC impingement , I
should use 726.10

thank you!

 

[BradSW]

For the sake of surgery coding I generally code the diagnosis codes in order with the procedure codes; you'll be billing 29827 for RCR, 29826-51 for ASD, 29824 for DCR, and you can also try coding 29825-59 for lysis of adhesions although it's bundled with the other codes it sounds like their was some excessive scarring. So in the same order I would code 726.10, 726.2, 715.91, 726.0. Otherwise for impingement I'd code the primary cause first (726.10 or 715.91) than code 726.2 following that. If an injection is given during an office visit you can than use 726.10 or 715.91 for the visit with a modifier 25 and than use 726.2 for the injection.