In patients with chronic rotator cuff disease, loss of the glenohumeral force couple, generated by the rotator cuff, results in superior subluxation of the humeral “head” and attenuation of tendon and joint capsule. Tissue degeneration also results in a high risk of failure when using more traditional repair techniques. In this setting, it may be necessary to augment the rotator cuff repair (complete or partial) with reconstruction of the superior joint capsule. In summation, restoration of the superior capsule creates a static restraint to superior migration and serves an internal splint to augment a rotator cuff repair. While the combination of these techniques for management of rotator cuff disease is a new
concept, the individual surgical procedures have established diagnostic and procedural codes. When the surgeon performs both procedures, we recommend 29827 for coding of rotator cuff repair and 29806 for capsular reconstruction.

In a SCR, the surgeon may use autograft or allograft tissue to reconstruct or repair deficient capsular tissues. As such, they should report 29806 when the technique is performed arthroscopically. If the surgeon also performs an arthroscopic repair, the residual rotator cuff tissue (complete or partial) 29827 should also be reported.

The surgeon should be sure to document restoration of the deficient superior capsular tissue and reduction of superior subluxation of the glenohumeral joint. The surgeon should also be sure to document the details of their repair of the rotator cuff tissue.

-In summary the above procedure, for myself, is currently coded as 29827, 29806-59 and when using dermal matrix for soft tissue reinforcement 17999 is applied. There is not a lot of documentation regarding the correct coding of the procedure described above; my question is how is it being coded within the Ortho community, and how are you handling denials for the portion 29806 represents? Am I not correct in splitting the superior capsular reconstruction from the rotator cuff repair, and is the biological implant for soft tissue reinforcement considered inclusive? If so, please direct me to supporting documentation.