Sara82
Guru
29806 - Anterior
29806/59 - Posterior
29807/59 - SLAP
29826/59 - Sub Decompression
29823/59 - Debridement
The above codes are what Im getting from the report. Ive never billed for so many labral repairs together, and wanted to see if any other coders that had more experience with shoulders could give me a thumbs up ont he above codes or advice in how to correctly bill for these.
And also what ICD 9 Code I would use for the Anterior & Posterior Labral Tears. Any help is appriciated! Thanks!
OPERATION PERFORMED:
Left shoulder arthroscopy with extensive glenohumeral joint
debridement, posterior labral repair, anterior labral repair, and
superior labral anteroposterior repair. We also did a
subacromial decompression.
A probe was inserted. Diagnostic arthroscopy was performed.
There was significant tear of the anterior, superior, and
posterior labrums. These were identified with a probe. The
anterior labrum was torn completely from the 7 o'clock position
superiorly incorporating the superior labrum. There was
disruption of the biceps tendon that was continuous with the
superior anterior aspect of the labrum that extended up into the
biceps tendon. The superior labrum was also torn completely with
a type 2 SLAP. This extended posteriorly to the posterior labral
tear that extended posteriorly to the approximate 4 o'clock
position. There was significant debris throughout the
glenohumeral joint. This was debrided using the 4.5 shaver.
There was significant fraying throughout this labral tissue. It
was all debrided using the 4.5 shaver. There was synovitis
throughout the posterior and superior aspects of the capsule. It
was all debrided using the 4.5 shaver. There were no loose
bodies in the axillary pouch. The articular surfaces of both the
humeral head and glenoid showed some grade 2 chondral change.
There was a significant Hill-Sachs deformity noted. The
undersurface of the rotator cuff was intact. Attention was first
directed towards the posterior labrum. The scope was placed in
the anterior portal and the elevator was placed in the posterior
portal. The posterior labral tear was then elevated. Once
adequate elevation was achieved, the tissue was appropriately
mobilized. A rasp was then used to rough up the bone as well as
the labral tissue. 2 JuggerKnot anchors were then placed over
the posterior glenoid. These anchors were then used to secure
the labral tissue to the prepared glenoid rim. Once this was
complete, the tails were appropriately cut, arthroscopic
instruments were then removed and the arthroscope was then placed
in the posterior portal and attention was directed towards the
anterior labrum. 2 JuggerKnot anchors were then placed
inferiorly in the glenoid. Each of these anchors were then used
to secure inferior capsular and labral tissue to the anterior
inferior aspect of the glenoid. Then three 3.0 mm Bio-SutureTak
anchors were then placed over the middle and anterior superior
aspect of the glenoid. The capsular and labral tissue was then
repaired to the glenoid. Once these knots were tied, and tails
were appropriately cut, attention was then directed to the SLAP
tear. The arthroscope was placed in the posterior portal. A
trans tendinous portal was established using a spinal needle and
a knife used to dissect through the skin and subcutaneous tissue.
A sharp trocar was then used to place two 3.0 mm Bio-SutureTak
anchors in both the anterior and posterior aspects of the biceps
insertion on the superior glenoid. These were then passed around
the labral tissue and tied sequentially. Care was taken to
ensure appropriate reduction of the biceps anchor to the superior
aspect of the glenoid. Once this was complete and appropriate
tails were cut, the labral repair circumferentially was inspected
and felt to be appropriate. Once this was complete, the
glenohumeral joint was then copiously irrigated with normal
saline. A spinal needle was used to place a PDS suture through
the lateral edge of the rotator cuff. It was managed to the
anterior portal. All the instruments were then removed from the
glenohumeral joint and a trocar was used to redirect the cannula
into the subacromial space. Once in the subacromial space
through the posterior portal, a spinal needle was used to
identify the location of the lateral portal. Once this lateral
portal position was identified, a trocar was used to dilate the
portal. A 5.5 shaver was then introduced. A subacromial
decompression was performed and all bleeding points were stopped
with electrocautery. Once this was complete, ArthroCare was used
to resect the soft tissues on the undersurface of the acromion
including the coracoacromial ligament. Once this was complete, a
significant subacromial spur was noted. A 5.5 bone-cutting
shaver was then used to perform an acromioplasty. Once this
acromioplasty was complete, the resection was inspected and felt
to be appropriate. All bony debris was then removed from the
subacromial space.
29806/59 - Posterior
29807/59 - SLAP
29826/59 - Sub Decompression
29823/59 - Debridement
The above codes are what Im getting from the report. Ive never billed for so many labral repairs together, and wanted to see if any other coders that had more experience with shoulders could give me a thumbs up ont he above codes or advice in how to correctly bill for these.
And also what ICD 9 Code I would use for the Anterior & Posterior Labral Tears. Any help is appriciated! Thanks!
OPERATION PERFORMED:
Left shoulder arthroscopy with extensive glenohumeral joint
debridement, posterior labral repair, anterior labral repair, and
superior labral anteroposterior repair. We also did a
subacromial decompression.
A probe was inserted. Diagnostic arthroscopy was performed.
There was significant tear of the anterior, superior, and
posterior labrums. These were identified with a probe. The
anterior labrum was torn completely from the 7 o'clock position
superiorly incorporating the superior labrum. There was
disruption of the biceps tendon that was continuous with the
superior anterior aspect of the labrum that extended up into the
biceps tendon. The superior labrum was also torn completely with
a type 2 SLAP. This extended posteriorly to the posterior labral
tear that extended posteriorly to the approximate 4 o'clock
position. There was significant debris throughout the
glenohumeral joint. This was debrided using the 4.5 shaver.
There was significant fraying throughout this labral tissue. It
was all debrided using the 4.5 shaver. There was synovitis
throughout the posterior and superior aspects of the capsule. It
was all debrided using the 4.5 shaver. There were no loose
bodies in the axillary pouch. The articular surfaces of both the
humeral head and glenoid showed some grade 2 chondral change.
There was a significant Hill-Sachs deformity noted. The
undersurface of the rotator cuff was intact. Attention was first
directed towards the posterior labrum. The scope was placed in
the anterior portal and the elevator was placed in the posterior
portal. The posterior labral tear was then elevated. Once
adequate elevation was achieved, the tissue was appropriately
mobilized. A rasp was then used to rough up the bone as well as
the labral tissue. 2 JuggerKnot anchors were then placed over
the posterior glenoid. These anchors were then used to secure
the labral tissue to the prepared glenoid rim. Once this was
complete, the tails were appropriately cut, arthroscopic
instruments were then removed and the arthroscope was then placed
in the posterior portal and attention was directed towards the
anterior labrum. 2 JuggerKnot anchors were then placed
inferiorly in the glenoid. Each of these anchors were then used
to secure inferior capsular and labral tissue to the anterior
inferior aspect of the glenoid. Then three 3.0 mm Bio-SutureTak
anchors were then placed over the middle and anterior superior
aspect of the glenoid. The capsular and labral tissue was then
repaired to the glenoid. Once these knots were tied, and tails
were appropriately cut, attention was then directed to the SLAP
tear. The arthroscope was placed in the posterior portal. A
trans tendinous portal was established using a spinal needle and
a knife used to dissect through the skin and subcutaneous tissue.
A sharp trocar was then used to place two 3.0 mm Bio-SutureTak
anchors in both the anterior and posterior aspects of the biceps
insertion on the superior glenoid. These were then passed around
the labral tissue and tied sequentially. Care was taken to
ensure appropriate reduction of the biceps anchor to the superior
aspect of the glenoid. Once this was complete and appropriate
tails were cut, the labral repair circumferentially was inspected
and felt to be appropriate. Once this was complete, the
glenohumeral joint was then copiously irrigated with normal
saline. A spinal needle was used to place a PDS suture through
the lateral edge of the rotator cuff. It was managed to the
anterior portal. All the instruments were then removed from the
glenohumeral joint and a trocar was used to redirect the cannula
into the subacromial space. Once in the subacromial space
through the posterior portal, a spinal needle was used to
identify the location of the lateral portal. Once this lateral
portal position was identified, a trocar was used to dilate the
portal. A 5.5 shaver was then introduced. A subacromial
decompression was performed and all bleeding points were stopped
with electrocautery. Once this was complete, ArthroCare was used
to resect the soft tissues on the undersurface of the acromion
including the coracoacromial ligament. Once this was complete, a
significant subacromial spur was noted. A 5.5 bone-cutting
shaver was then used to perform an acromioplasty. Once this
acromioplasty was complete, the resection was inspected and felt
to be appropriate. All bony debris was then removed from the
subacromial space.
