BFAITHFUL
Expert
Dr. says to bill cpts 29826, 29824 & 29825 but I don't think 29825 should be billed as its inclusive, but what about 29822-59 for debridement of RC, subscapularis interval & synovitis in the subscapular space? my reasoning being the debridement was in diff. compartment (glenohumeral)????
A posterior portal was used for insertion of a 4mm 25 degree arthroscope, which infused Ringer's lactate via arthroscopic pump, The insertion was difficult due to the adhesive capsulitis, Therefore, the shoulder was first distended with 40cc of Ringer's lactate. Once this was accomplished, there was scarring of the subscapularis rotator cuff interval. Under direct visualization first identifying an 18 gauge spinal needle, an anterior portal was made and 6mm cannula was dilated and inserted. A 4.5 shaver was introduced to debride the rotator cuff, subscapularis interval and the synovitis in the subscapular space. This was also performed with the bipolar radiofrequency wand. After this was accomplished, external rotation increased to 80 degrees, but however not to 90 degrees. The arthroscope was redirected in the subacromial space and through a direct lateral portal, first identifying an 18 gauge spinal needle, a 4.5 shaver was introduced to debirde the scarred acromiocoracoid ligament and the undersurface of the acromion. Through a posterior portal, placing the arthroscope in a direct lateral portal, an anterior acromioplasty was performed as well as a resection at the distal clavicle, which was performed with an unsheathed burr. Once this was accomplished, adhesions were resected with a shaver through the posterior portal from anterior to posterior on the lateral portion. This slightly imporved external rotation, however, once this was completed, the arthroscope and cannula were removed.
A posterior portal was used for insertion of a 4mm 25 degree arthroscope, which infused Ringer's lactate via arthroscopic pump, The insertion was difficult due to the adhesive capsulitis, Therefore, the shoulder was first distended with 40cc of Ringer's lactate. Once this was accomplished, there was scarring of the subscapularis rotator cuff interval. Under direct visualization first identifying an 18 gauge spinal needle, an anterior portal was made and 6mm cannula was dilated and inserted. A 4.5 shaver was introduced to debride the rotator cuff, subscapularis interval and the synovitis in the subscapular space. This was also performed with the bipolar radiofrequency wand. After this was accomplished, external rotation increased to 80 degrees, but however not to 90 degrees. The arthroscope was redirected in the subacromial space and through a direct lateral portal, first identifying an 18 gauge spinal needle, a 4.5 shaver was introduced to debirde the scarred acromiocoracoid ligament and the undersurface of the acromion. Through a posterior portal, placing the arthroscope in a direct lateral portal, an anterior acromioplasty was performed as well as a resection at the distal clavicle, which was performed with an unsheathed burr. Once this was accomplished, adhesions were resected with a shaver through the posterior portal from anterior to posterior on the lateral portion. This slightly imporved external rotation, however, once this was completed, the arthroscope and cannula were removed.