Wiki Remplissage

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kcoyne1109

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I'm stuck on this surgery. the doctor want 29806, 29827(remplissage) and 29823. There is no rotator cuff tear. And everything I've read says either 29806-22 or 29806 and 29999(remplissage, comparable code 29827). Does anyone any suggestions or advice?

2. DIAGNOSTIC ARTHROSCOPY, DEBRIDEMENT AND REMPLISSAGE ANCHOR PLACEMENT: At this point, I began with a standard diagnostic arthroscopy using a posterior portal, anterior superior portal, and mid glenoid portal with an 8 mm cannula. The findings were as described above. I then began extensive debridement of the synovitis using a combination of a shaver and radiofrequency wand. I debrided this back to a stable capsule. We then turned our attention to the Hill-Sachs defect. There was interval scar tissue formation within the defect. A ring curette was introduced through the posterior portal and a gentle abrasion of the Hill-Sachs lesion was performed to allow for placement of the anchors. We then proceeded to place a fiber tack anchor inferiorly using a percutaneous technique. A second anchor was placed superiorly. The initial plan was for a knotless fixation. We attempted to shuttle the suture however the shuttling mechanism was unable to pass the working stitch. We then remove the sutures from the knotless fiber tacks and placed a single corkscrew anchor within the mid defect. Using a arthro-pierce suture retrieving device 3 limbs of mattress sutures from the medial to lateral direction was utilized to shuttle the sutures through a percutaneous fashion.
3. CAPSULOLABRAL PREPARATION: With the scope in the anterior-superior portal, I now prepared the labrum with a combination of elevators, a small bone cutting shaver, and a power rasp. I was able to elevate the labrum fully, see the subscapularis fibers posteriorly, and make sure we had good 100 degree preparation of the labrum. Of note, this was a bone preserving procedure making sure that we had preserved bone and just freshened up the surfaces. The labrum was able to float freely and back to the anatomic position.
4. CAPSULOLABRAL REPAIR - ANTERIOR AND INFERIOR: The anterior and inferior repairs were performed using a push lock anchor using suture tape . Starting at the 6 o'clock position in a percutaneous fashion the drill guide was inserted for the push lock anchor. We then proceeded to shuttle suture tape. We continued our repair continue anteriorly reapproximate and anterior labrum and capsule back to the glenoid rim. Following her labral repair we then proceeded to tie the Remplissage for sterilely and a sliding knot fashion. Reduction of the posterior infraspinatus tendon and capsule was directly visualized. This provided an excellent bumper effect preventing increased anterior translation of the humeral head. The shoulder with ranging of the little engagement healed defect in the anterior glenoid labrum.
 

Remplissage Procedure

Looking for anyone who is familiar with the coding of this procedure. We have tried different codes. We do use unlisted code 29999. Some articles I have read state to use CPT code 29827. Others state, if doing the procedure with 29806, add the modifier 22. Any feedback would be much...
www.aapc.com

I have not checked recently. You would want to check CPT Assistant to make sure. However, reporting 29827 for remplissage is incorrect.
I would need to see the whole redacted report with headers to double check this one.
 
Forgot to add:

With the snippets you have there, 29823 & 29827 are not documented. All I am seeing is 29806 (depending on if this is the whole op note and what the post-op documented diagnoses were). 29823 can't be credited because there is no documentation of three or more discrete structures. 29822 can't be credited because it would be included. The debridement seen in your snip is almost all related to the performance and preparation for 29806. Further, the remplissage is a bit poorly documented so I can't even tell if adding a 22 as suggested by some would be supported. I also don't think 29999 is appropriate here either with what you have snipped.


See NCCI Manual Chapter 4: https://www.cms.gov/files/document/medicare-ncci-policy-manual-2024-chapter-4.pdf
7. Shoulder arthroscopy procedures include limited debridement (e.g., CPT code 29822) even if the limited debridement is performed in a different area of the same shoulder than the other procedure. With 3 exceptions, shoulder arthroscopy procedures include extensive debridement (e.g., CPT code 29823) even if the extensive debridement is performed in a different area of the same shoulder than the other procedure. CPT codes 29824 (Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure), 29827 (Arthroscopy, shoulder, surgical; with rotator cuff repair), and 29828 (Arthroscopy, shoulder, surgical; biceps tenodesis) may be reported separately with CPT code 29823 if the extensive debridement is performed in a different area of the same shoulder.
 
amyjph said:
Forgot to add:

With the snippets you have there, 29823 & 29827 are not documented. All I am seeing is 29806 (depending on if this is the whole op note and what the post-op documented diagnoses were). 29823 can't be credited because there is no documentation of three or more discrete structures. 29822 can't be credited because it would be included. The debridement seen in your snip is almost all related to the performance and preparation for 29806. Further, the remplissage is a bit poorly documented so I can't even tell if adding a 22 as suggested by some would be supported. I also don't think 29999 is appropriate here either with what you have snipped.


See NCCI Manual Chapter 4: https://www.cms.gov/files/document/medicare-ncci-policy-manual-2024-chapter-4.pdf
7. Shoulder arthroscopy procedures include limited debridement (e.g., CPT code 29822) even if the limited debridement is performed in a different area of the same shoulder than the other procedure. With 3 exceptions, shoulder arthroscopy procedures include extensive debridement (e.g., CPT code 29823) even if the extensive debridement is performed in a different area of the same shoulder than the other procedure. CPT codes 29824 (Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure), 29827 (Arthroscopy, shoulder, surgical; with rotator cuff repair), and 29828 (Arthroscopy, shoulder, surgical; biceps tenodesis) may be reported separately with CPT code 29823 if the extensive debridement is performed in a different area of the same shoulder.
Click to expand...
that was the whole procedure note that i posted in the original post but this is the rest preop and post op dx. I appreciate your help!!
PREOPERATIVE DIAGNOSES:
1. Right shoulder anterior instability
2. Anterior glenoid bone loss, 5 %
3. Anterior labral tear with thinning of the labral tissue
4. Off-track Hills Sachs lesion

POSTOPERATIVE DIAGNOSES AND FINDINGS:
1. Exam under anesthesia: (Right shoulder anterior translation 2, posterior translation 0, inferior sulcus N. Forward flexion 140 deg. Abduction 100 deg. ER at side 70 deg. ABER 100 deg. ABIR 80 deg.
2. Anterior glenoid bone loss, 5-10%
3. Humeral head with hill-sachs, medium
4. Anterior labral tear.
5. Posterior labral intact.
6. No evidence of HAGL.
7. No GLAD lesion
8. Biceps okay, No SLAP tear.
9. Rotator cuff intact.

PROCEDURES PERFORMED:
1. Right arthroscopic capsulolabral repair, requiring 3 total anchors and a 100 degree repair.
2. Arthroscopy with extensive intra-articular debridement of synovitis in the rotator interval, and posterosuperior capsule.
3. Remplissage of posterior capsule and infraspinatus to Hills-Sachs defect (29827)
 
It even says rotator cuff intact...

It a technique. Check out the other discussions about it in the linked thread if you have not yet. Unless there is any new direction in CPT Asst. or some other reputable source, it's 29806.
In my opinion it's a technique used as part of the Bankart if done during 29806. If documented well and the 22 is justified, you would append modifier 22 to 29806. Prepare for a records request, possibly delayed payment, and be sure to verify the reimbursement for the 22. I doubt you would ever see additional payment for reporting 29999 especially if you attempted to code it along with 29806.
They can also call it extensive debridement all they want, but if it is debridement related to the primary procedure such as prepping the area, cleaning up the capsule, labral prep, etc. they can't separately count that as a discrete structure in order to get 29823. If talking synovitis, that leaves you with only one structure which is 29822 which is not separately reportable. (Unless WC or some payer that does not follow standard CMS/NCCI etc.).
If the provider pushes back, use the NCCI manual, AAOS Global Service Data Book, and the P2P edits.
I would also be looking for a statement or other documentation to support using a 22 modifier which is not present here. https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00135206 (example info).

Remplissage is probably a top 10 ortho scope coding question for shoulder guys.
 
amyjph said:
It even says rotator cuff intact...

It a technique. Check out the other discussions about it in the linked thread if you have not yet. Unless there is any new direction in CPT Asst. or some other reputable source, it's 29806.
In my opinion it's a technique used as part of the Bankart if done during 29806. If documented well and the 22 is justified, you would append modifier 22 to 29806. Prepare for a records request, possibly delayed payment, and be sure to verify the reimbursement for the 22. I doubt you would ever see additional payment for reporting 29999 especially if you attempted to code it along with 29806.
They can also call it extensive debridement all they want, but if it is debridement related to the primary procedure such as prepping the area, cleaning up the capsule, labral prep, etc. they can't separately count that as a discrete structure in order to get 29823. If talking synovitis, that leaves you with only one structure which is 29822 which is not separately reportable. (Unless WC or some payer that does not follow standard CMS/NCCI etc.).
If the provider pushes back, use the NCCI manual, AAOS Global Service Data Book, and the P2P edits.
I would also be looking for a statement or other documentation to support using a 22 modifier which is not present here. https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00135206 (example info).

Remplissage is probably a top 10 ortho scope coding question for shoulder guys.
Click to expand...
thank you so much much for your responses! They are very helpful!
 
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