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Arthroscopic meniscectomy

Would the following documentation suffice for a lateral meniscectomy?

The lateral compartment contained some free-edge fraying of the posterior horn and body of the
lateral meniscus. This was débrided with a 4.5 shaver. The rest of the meniscus was probed
and found to be stable. The cartilaginous surfaces were in good condition in lateral
compartment.

If so, do you have any references?

thanks

Medical Billing and Coding Forum

Arthroscopic shoulder procedure questions

Hi All!

I am trying to figure out how to code some arthroscopic procedures and the more I try to figure it out the more I am confusing myself! :confused: If some one could help explain this to me it would be appreciated!!

First – if the doctor does a subacromial decompression along with other procedures (i.e. rotator cuff repair, debridement, etc.) but does not do an acromioplasty can I still use 29826 or does the acromioplasty need to be done to use that code? And if it can’t be used, what code would be used?

Second – my doctors are documenting that they did an arthroscopic Suprascapular nerve decompression at the same time as other procedures (i.e. rotator cuff, debridement, tendodesis, etc.). Is this billed separately or bundled with the other procedures. If it is billable, the unlisted arthro code 29999 would be billed, however what code would this be comparable to?

Any help would be appreciated. I am hoping for an answer as soon as possible as my claim is pending for the right answer!!

Thanks!!

Jodi Dibble. CPC, COC

Medical Billing and Coding Forum

Arthroscopic Biceps Tenotomy

I know that Arthroscopic Biceps Tenotomy is coded as CPT 29822 (limited debridement). The surgeon also performed Arthroscopic Rotator Cuff Repair, AC joint resection and Subacromial decompression & acromioplasty. I know that with the limited debridement, it can’t be coded separately per the NCCI edit. Can the 29822 for Biceps tenotomy be billed separately?

Medical Billing and Coding Forum

Arthroscopic shoulder procedure w/open rotator cuff repair

Help please… I am having a issue with our Physician. He does not think he is getting paid for everything he is doing. I am trying to be vigilant in using the correct codes but these modifier edit’s are confusing me even more now…could be overthinking. Any advice would be so greatly appreciate…. always a learning profession….

Am I understanding this or am I way off…

Want to code this way: 23410-LT 29828-59, 29826-59 and 29823. Not use 29820

29828, 29826 29823 (NCCI edit Presence of an anatomic site modifier on this code(s) 23410 is suppressing NCCI edit. Check documentation to determine whether both code pair(s) can be billed or an additional site modifier added)

29820 (NCCI Edit.. Code 2 of a code pair with 29828 29823 that would be allowed if an approp. NCCI modifier were present.)

DX: Acute massive RTC tear, bicep tenosynovitis, labral fraying with impingement, synovitis of the glenohumeral joint

Surgery: Arthroscopy left shoulder w/extensive debridement of the labrum, partial synovectomy, subacromial decompression with acromioplasty with bicep tenodesis and open acute roatator cuff repair

PROCEDURE:
introduced the trocar into the glenohumeral joint atraumatically and began a diagnostic arthroscopy, which demonstrated a
massive rotator cuff tear, biceps tenosynovitis with a torn labrum at the biceps insertion synovitis through the shoulder.
I performed a biceps tenotomy, which was later repaired. I debrided the stump of the biceps, utilized a shaver to circumferentially debride the labrum, and then utilized a Werewolf RF to perform a partial synovectomy of the glenohumeral joint. Once completed, I then placed the scope into the subacromial space. I started a standard anterior lateral portal and with the use of a Werewolf and shaver,
performed a subacromial decompression and bursectomy. I then identified a large spur on the acromion and performed an acromioplasty with a burr, co-planing it with the AC joint. Once completed, I then made the decision to open the rotator cuff. I then extended my
anterior lateral portal superiorly and slightly inferiorly, dissected down through the subcutaneous tissue with scissor dissection and elevated medial and lateral flaps over the deltoid fascia and then split the deltoid and the raphe between the anterior and lateral delts. I then placed a Link retractor. I identified the bicipital groove by externally rotating. I incised the transverse ligament and the pulled the biceps through the incision. I then placed a 1.8 mm Q-Fix anchor at the top of the bicipital groove. I rasped the entire groove and then whipstitched the biceps tendon with the suture from the Q-Fix. I reduced it within the bicipital groove and then tied knots over the top. I then utilized
the remaining suture to repair the transverse ligament. I then identified the massive rotator cuff tear. I debrided the insertion with a rasp and rongeur and got down to a bed of good bleeding bone and then placed three 5.5 Healicoil suture anchors along the articular margin. Each one had good bite. I then sequentially passed all twelve sutures through the rotator cuff in standard fashion. I then reduced the cuff down to the insertion and tied medial row knots. I then placed one suture from each one of the knots in an anterior lateral 5.5 mm MultiFIX-S Ultra suture anchor for my lateral row, reduced the cuff back down to the insertion very well and then repeated those same steps with the
more posterior lateral 5.5 MultiFIX-S Ultra. Overall, I was extremely happy with the reduction of the rotator cuff and the overall repair. I then thoroughly irrigated out the wound. I documented the repair with a picture and then closed the deltoid fascia with running #0 Vicryl. The subcutaneous layer was then closed with a #2-0 Vicryl and the anterior and lateral portals were closed with #3-0 nylon. I then dressed the lateral wound with Dermabond, Steri-Strips, Xeroform, 4x4s, ABDs, and Medipore tape. The patient was placed in an UltraSling, an Iceman was applied, and he was taken to PACU in stable condition.

Medical Billing and Coding Forum

is an arthroscopic biceps tenotomy inclusive to extensive debridement

We were just told by our State Labor and Industries review department for prior authorization (Qualis) that per AAPC Coding guidelines, and arthroscopic biceps tenotomy (CPT 29999 compared to 23405) is inclusive to an arthroscopic debridement (29823), however, according to AAOS, these are not inclusive codes as well as looking at the NCCI guidelines Ch 4 section E subsection 7 –

7. Shoulder arthroscopy procedures include limited debridement (e.g., CPT code 29822) even if the limited debridement is performed in a different area of the same shoulder than the other procedure. With three exceptions, shoulder arthroscopy procedures include extensive debridement (e.g., CPT code 29823) even if the extensive debridement is performed in a different area of the same shoulder than the other procedure. CPT codes 29824 (arthroscopic claviculectomy including distal articular surface), 29827 (arthroscopic rotator cuff repair), and 29828 (biceps tenodesis) may be reported separately with CPT code 29823 if the extensive debridement is performed in a different area of the same shoulder.

There were 2 separate arthroscopic portals made one was posterior and then once tenotomy was complete scope was removed and an lateral acromial anterior portal was made.

Can someone tell me where this guidelines is… as I now have conflicting information.

Thank you in advance!!!!

Medical Billing and Coding Forum

Arthroscopic assisted reduction/percutaneous pinning distal tibial fracture

Would 29855 work for distal tibial fracture? I’m thinking that I need percutaneous pinning code but I can’t find one for the distal tibial fracture. Op note states that the reduction was through the scope and the anterior ridge revealed some increased displacement so a small open incision was then placed to remove invaginated periosteum. then stab incision was made to place K-wire. Can anyone help?

Medical Billing and Coding Forum

Need Help for Arthroscopic Superior Capsule Reconstruction cpt code ???

he did
Arthroscopic assist superior capsular reconstruction ( 29999 ) ??? or 29806-22
open subacromial decompression ( 23130 )
distal clavicle excision ( 23120 )
biceps tenodesis ( 23430 )
open rotator cuff repair to the superior capsule ( 23412 )

any feedback on all of this.

thanks

Medical Billing and Coding Forum

Arthroscopic Shoulder surgery

29822 vs 29823
Does the physician have to document "extensive" before we code 29823?

Or can we bump up to 29823 if these were documented?
• Removal of osteochondral and/or chondral bodies AND
• Biceps tendon & rotator cuff debridement AND
• Abrasion arthroplasty

The more I research these codes the more I confuse myself. Please help me…I start this audit on Monday.

Medical Billing and Coding Forum

arthroscopic SAD, mini open rotator cuff repair

I am in dire need of some coding guidance. Surgeon did an arthroscopic subacromial decompression (29826), then extended the anterolateral portal to perform a mini open rotator cuff repair (23412). Per NCCI edits, 29826 can have a modifier added if appropriate. Am I correct in thinking it would NOT be appropriate to append a modifier to 29826 (even thougt it is arthroscopic) when reported with 23412, the mini open rotator cuff repair when done on the same shoulder since a rotator cuff repair generally includes a subacromial decompression with acromioplasty?
Can you tell me where I might find references on this?
thanks so much for any insight!

Medical Billing and Coding Forum