Wiki Shoulder Arthroscopy w/Cuff Repair

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coderguy1939

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Doctor removed calcific depositis arthroscopically from the supraspinatus and infraspinatus leaving a large defect that had to be repaired. Can cuff repair be coded if the defect is created by the surgeon?
 
There was found to be fairly extensive enlarged calcific deposits emanating with the posterior edge of the supraspinatus and more anterior leading edge of the infraspinatus tendons. Barbotaging was performed with a spinal needle and upon extensive removal of all calcium deposits, there was a fairly decent sized rent that was noted to be left behind within the tendinous tissues. Because of the size of the tear within the cuff there was a decision to perform a side to side suturing of the particular defect. This was done by passing a three #2 FiberWire suture from anterior to posterior direction across the rent. Bird beak devices were used as were the Linvatec shuttle relay system. It was then arthroscopically tied. The one suture nicely re-opposed the tissues back into normal anatomic position.
 
What the patients pre-op and post operative diagnosis? I'm leaning more towards that the calcium deposits had to be removed to get to the defect and that the definitive final procedure was the cuff repair but dont hold me to that yet.

other thoughts on this note?
 
Based on the details in the body of the report, it doesn't seem like the tear exists until after the removal of the calcium deposits. He notes the calcific deposits in the supraspinatus and infraspinatus but no tear until after removal of the the deposits and then he is repairing the tendons he was debriding. I'm approaching it from that angle and if that is the case is the cuff repair codable? Thanks.
 
If the defect was truly caused by the removal of the calcific deposits, then I would lean towards a "no" because the defect was created by the surgeon. If in fact the tear was found once the deposits were removed, then I would go with the RCR. Personally I would discuss this with the surgeon to get more information about this case.
 
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