Wiki ROTATOR CUFF GRAFTLINK DERMAL ALLOGRAFT

cwilson3333

Expert
Messages
290
Location
Hamilton, VA
Best answers
0
NEED HELP CODING THIS PROCEDURE
Title: Arthroscopy, Decompression, Graftlink Dermal Allograft to Supraspinatour tendon

Description o Procedure:
The patient ws taken to the OR , placed in supine position afte induction of block. Place in beach chair position. Right shoulde ws prepped and draped in usual sterile fashion. Glenohumeral joint infiltrated with 50 ml. normal saline. Posterior portal made and arthroscope placed into glenohumeral joint posterior portal. Anterior portal was made under direct vision at rotator cuff interaval, shoulder examined. The subscap tendon was normal. Long head of biceps normal as was the detachment of the superior labrum. Undersurface of supraspinatus and infraspinatus tendons had fairly minimal changes, no significant tearing. Scope placed in subacromial space. Lateral portal was made. A bur was placed in lateral portal. Soft tissue was taken off undersurface of acromion. Decompression performed with use of bur. 3 mm bone removed anteriorly and gently contoured posteriorly. Bursectomy performed on bursal sideto expose supraspinatus tendon. No obvious tearing. Some Fraying. Synovectomy performed and thorough debridement of all the bursa in the supraspinatus tendon as well as laterla to this along the proximal humerus. Total of 4 portals were made. The GraftLing graft was then placed through a lateral portal throug a PassPort. Four Fibertaks were placed to secure the graft. The shoulder was drained. Portals were closed with 3-0 Monocryl sucuticular suture. Benzoin and Steri-Strips were placed followed by sterline dressing, a sling and swath. Patient was extubated and transferred in stable condition.
 
Your biggest issue is medical necessity. The surgeon has basically said in his/her operative report that the supraspinatus looked normal both on the articular and bursal side with a bit of fraying at most. So why would anyone consider a dermal allograft medically necessary? This is a -poor- operative note, and if the surgeon cannot get reimbursed, it is his/her own fault.

The rotator cuff was not repaired, so you cannot code 29827. Dermal allograft augmentation would be unlisted.
In most cases, 29826 is not separately reimbursable, and the bursa and lateral acromion would be two structures for the purposes of debridement.

Thus, I would code 29822, 29999 (with comparison to 29827) and just not expect to be paid for the latter.
 
Top