Wiki Superior Capsular Reconstruction

[scooter1]

Physician did a Superior Capsular reconstruction for an irreparable rotator cuff tear. In my research on how to code this, I have seen several different ways of coding this procedure. I have seen 29806 ( and some add a 22 modifier), I have seen 29827, I have also seen 29999 and compare to 23420. I have never had much luck with getting payment on the unlisted code when I have used it previously, so I was hesitant with using it for this procedure.
Can anyone give me insight if any of these scenarios are correct or should it be something else? And also, have you had any luck with receiving payment ? It seems the physician has put a lot of work into this procedure what with the graft and everything. I would like to do the correct code. Thank you for any help

 

[Orthocoderpgu]

Read reply from an ortho doc

Unfortunately you don't give a lot of detail or information, so I am "assuming/guessing" that this is a shoulder surgery case. As such, the "superior capsule" of the shoulder joint is the Rotator Cuff[. To say that it was a "reconstruction" indicates that it was a severe/extensive/large/complex and probably chronic tear requiring a lot of hard work to repair it. Regardless of the severity and complexity of the tear and its repair, the code for Arthroscopic Rotator Cuff Repair is 29827 assuming it was all done arthroscopically and that was all that was done.The Code 29999: Unlisted arthroscopic procedure is essentially meaningless, and should only be used as a very last resort, and has to be "paired" with a code that most closely matches the procedure done in its complexity.

I hope this helps you some.

Respectfully submitted, Alan Pechacek, M.D.

 

[shecodes]

You didn't mention if this was done arthroscopically or not, but since you mention 29806 and 29827, I'm making the assumption that it was.

Per CPT Assistant from April 2017, the correct code to report ASCR (arthroscopic superior capsular reconstruction) is 29999. In light of this information, it would be inappropriate to code this as 29806 or 29827.

Most payers will deny up front and request additional documentation. Once this information is provided, typically it will be paid. It would probably be beneficial to include a copy of the CPT Assistant along with other supporting documentation. YMMV

 

[cwilson3333]

Massive Chrinic rotator Cuff Tear

Title of Procedure
Arthroscopy, Biceps Tenotomy, Decompression, Superior Capsular Reconstruction [graft was used] , Repair of Subscapularis Tear, Repair Infraspinatus Tear

Without entering description of procedure, would like to know if I am looking at this coding
CPT 29806
CPT 29827
CPT 29826

Operative note was rather extensive to include.
Sorry

 

[MI_CODER]

An arthroscopic superior capsular reconstruction (ASCR) is coded as 29999.

CPT Assistant, April 2017 Page: 9 Category: Frequently Asked Questions:

Question:

How should an arthroscopic superior capsular reconstruction (ASCR) for an "irreparable" supraspinatus tear in the shoulder be reported?

Answer:

Currently, there is no specific CPT code to report an arthroscopic superior capsular reconstruction (ASCR). Therefore, it is appropriate to report code 29999, Unlisted procedure, arthroscopy. When reporting an unlisted code to describe a procedure or service, it is necessary to submit supporting documentation (eg, procedure report) along with the claim to provide an adequate description of the nature, extent, and need for the procedure; and the time, effort, and equipment necessary to provide the service

Without looking at the entire op report, I would code your (cwilson3333) op report as follows: 29827, 29999. You have to review the op report and make sure that a decompression of the subacromial space with partial acromioplasty was performed. If a partial acromioplasty was not performed then this would be coded as debridement and would be included in the rotator cuff repair code. If partial acromioplasty was performed then I would also code 29826.