Wiki Shoulder help needed

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dhuttie

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Dotor coded for the below codes PLUS an open Rotator Cuff Repair
Doctor starts out via scope doing acromioplasty (29826) and debridement of SLAP tear (29822) - removes instruments, makes 3cm incision, palpates the rotator cuff calcification, "...used a knife to open the superficial fibers of the supraspinatus and indentified the whitich material consistent with calcific tendonitis. At this point, we further split the tendon fromt he attachment proximally about 1 to 1.5cm. Carefully dissected the fibrinous white materal from within the supraspinatus as well as in front, behind and underneath the rotator cuff." Repaired the supraspinatus.

I don't feel he should charge for "repair of the rotator cuff" when he split it to remove the calcification - - Is there something more appropriate for this?
 
dhuttie said:
Dotor coded for the below codes PLUS an open Rotator Cuff Repair
Doctor starts out via scope doing acromioplasty (29826) and debridement of SLAP tear (29822) - removes instruments, makes 3cm incision, palpates the rotator cuff calcification, "...used a knife to open the superficial fibers of the supraspinatus and indentified the whitich material consistent with calcific tendonitis. At this point, we further split the tendon fromt he attachment proximally about 1 to 1.5cm. Carefully dissected the fibrinous white materal from within the supraspinatus as well as in front, behind and underneath the rotator cuff." Repaired the supraspinatus.

I don't feel he should charge for "repair of the rotator cuff" when he split it to remove the calcification - - Is there something more appropriate for this?
Click to expand...

was there a RC tear documented before procedure? He states 'repaired the supraspinatus" - Did he document sutures, anchors, etc?
 
nyyankees said:
was there a RC tear documented before procedure? He states 'repaired the supraspinatus" - Did he document sutures, anchors, etc?
Click to expand...

No, there was NO preoperative RC tear. Doctor split it in order to gain access to the calcification. He states it was repaired with Ethibond sutures (3 of them).
 
dhuttie said:
No, there was NO preoperative RC tear. Doctor split it in order to gain access to the calcification. He states it was repaired with Ethibond sutures (3 of them).
Click to expand...

Ok - so you cannot capture the RC repair. We have, in the past, billed out a calcification/deposit removal in the shoulder as an unlisted code. We have gotten paid on some but could not say for certain that you would get paid. But it' worth a shot.
 
nyyankees said:
Ok - so you cannot capture the RC repair. We have, in the past, billed out a calcification/deposit removal in the shoulder as an unlisted code. We have gotten paid on some but could not say for certain that you would get paid. But it' worth a shot.
Click to expand...

Thank you! I wasn't in agreement with capturing the RCR either.
As for the unlisted code, would it be comparable to a scope debridement (29822)?
 
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