"We then proceeded to mark the landmarks laterally and made a linear incision slightly lateral to the coracoid and extending to the deltoid attachment distally. Once through the skin and cutaneous tissues were dissected sharply down to the deltopectoral interval. We then identified the cephalic vein and attempted to move this medially. Bleeding did occur and this did have to be tied off with 0 silk sutures. Once the deltopectoral interval was entered we identified the lateral edge of the conjoined tendon and incised the clavipectoral fascia proximally and distally. We were then able to place a self retaining retractor into this interval for better visualization. We easily identified the shaft fracture as this was sitting directly behind the conjoined tendon. Once this plane was developed we identified that the biceps tendon and proceeded to perform a bicipital tenodesis to the intact pectoralis major insertion. We resected the remainder of the tendon and then placed traction sutures through the subscapularis muscle and around the lesser tuberosity fragment as well as posteriorly around the greater tuberosity fragment. We incised the upper 25% of the pectoralis major insertion and then receded to clean soft tissue out of the fracture site. Once this was cleaned we then manually reduce to fracture and verified this on AP fluoroscopy. We then were able to shift the humeral head in the position and with distal traction were able to achieve reasonable reduction we then selected a short Zimmer high proximal humerus plate f and placed this anterior laterally over the humerus just lateral to the pectoralis major insertion and just posterior to the bicipital groove. Once this was complete and held into position with threaded K wires AP and lateral images were obtained to ensure good reduction. Once this was confirmed, we proceeded to place a single standard 3 5 cortical screw using AO technicque distally in the oblong hole. Once this was adhered to the distal shaft, the proximalmost locking screw was then placed using standard AO technique. We then removed the K wires confirmed reduction on AP and scapular Y and then proceeded to place an additional 4 locking screws proximally. We then placed an additional 2 screws distally the second from the most distal hole was placed locking and the distalmost hole was placed nonlocking. Once this was complete final AP and lateral images were obtained. We copiously irrigated the incision site and reapproximated the skin with 2-0 Vicryl and staples."
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Arthroscopic Biceps Tenotomy
is an arthroscopic biceps tenotomy inclusive to extensive debridement
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!!!!
Soft Tissue Biceps Tenodesis
Inspection of Long Head Biceps Tendon
My provider is performing an arthroscopic rotator cuff repair and an inspection of the long head biceps tendon. Is there a code for the inspection or would I use an unlisted or maybe a modifier 22 with the RTC repair?
Thanks in advance.
…A longitudinal incision of about 2.5 cm was then made in the axilla. Blunt dissection was carried down to the short head biceps, which was retracted medially. The pec tendon was retracted laterally. Long head biceps was immediately identified in the bicipital groove. It was mobilized with a hemostat and we tried to mobilize it from its proximal attachment, but it had tenodesed itself down in the bicipital groove and was very stable. I could not mobilize it. With the elbow in extension, the tendon was tight and did not have any laxity, and it was not felt I could advance the long head biceps by cutting it and reattaching it to any significant degree, and it wasn’t felt that that would significantly change the muscular contour, and because it was tenodesed, I felt it would be functional, probably do fine, so the biceps was therefore left alone.
Arthroscopy, biceps tendon release and arthroscopic rotator cuff repair
Acromioplasty and claviculectomy were also done. So I thought you also code 29826-RT and 29824-RT. It seems that these must be included in the 29827-RT.
Biceps tenotomy
Ortho surgeon performed:
1. Left Should arthroscopy—-debridement is indicated as "labral debridement with use of an arthroscopic shaver"…
2. Biceps tenotomy
3. Subacromial bursectomy–not reported separately
3. Subacromial decompression
I found that the biceps tenotomy is reportable as an unlisted CPT code along with 29822 (limited debridement) and 29826.
But then I found that the biceps tenotomy is considered to be a debridement procedure. So that, along with the labral debridement, and the subacromial bursectomy would justify 29823 (extensive debridement).
Does anyone have any suggestions on deciphering all of this? Does the biceps tenotomy, and labral debridement and subacromial bursectomy = an extensive debridement? Our surgeon is indicating in his procedure statement that shoulder arthroscopy was with "limited labral debridement".
One CPC suggests billing 29822, 29826, and 29999. Another CPC suggests billing 29823 and 29826. I’m the CPC unsure of herself!
Thank you all for any input or suggestions…..