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Shoulder-Rotator cuff procedures with allograft, any official guidance?

Is there any official coding guidance on including a code for the application of allograft/xenograft in a rotator cuff reapir/reconstruction procedure or in shoulder arthroplasty . Lots of conflicting information on the web, posts on the forum, allograft manufacturer reimbursement guides. The AHA Coding Clinic from Q1 2006, looks to be more specific to the assignment of ICD-9 "Assign code 83.63, Rotator cuff repair, for the procedure performed. The allograft graft jacket was used to reinforce the repair and is captured with the code assignment for the repair."

Some contradictory information I have found:
– application of graft is included in the procedure so only code the RC procedure (23410, 23412, 23420, 29827) or arthroplasty (23470, 23472) alone.
– to add modifier -22 to the primary code
– to add code +15777 (although "ie, Breast,Trunk" is part of the code and per CPT Assistant Oct 2013, its use is only in the breast or trunk)
– to add code 17999

Can anyone offer help, I was excited to see an AAPC Shoulder coding article in the July Healthcare Business Monthly, but no mention of graft!

Thank you in advance!

Medical Billing and Coding Forum

Open Rotator Cuff Debridement

I have a case that an avulsed rotator cuff was treated by open debridement rather than repaired due to it being ‘not repairable’ any ideas?
-I’m not sure it would be appropriate to code a tenotomy being that it is avulsed, so its really not being released.
-repair seems out of the question
-29822 or 29823 seem appropriate, however this was done OPEN

please help!
**also I already know code for acromioplasty, only concerned with open debridement code. i’ll deal with the cci’s later**

The glenohumeral joint was injected with 50 mL of saline and then the
arthroscope was introduced posteriorly. There was found to be a massive
tear in the rotator cuff tendon with the edge of the tendon being just
lateral to the glenoid. On the MRI, it appeared there may be loose bodies
inferiorly, but none were found. There was only significant synovitis.
Her biceps tendon was intact. The arthroscope was then removed and an
incision was made at the anterolateral corner of the acromion. This was
taken through the skin and subcutaneous tissue sharply and electrocautery
was used for hemostasis. The deltoid was split between the anterior and
middle thirds and elevated off the anterior aspect of the acromion. The
acromion was exposed and then an acromioplasty was performed using a
micro-oscillating saw, removing the anterior-inferior 5 mm of the acromion.
This provided ample room in the subacromial space. Then, the rotator cuff
was evaluated. The biceps tendon was still intact, but the supraspinatus
tendon and infraspinatus tendon were completely avulsed and retracted back
almost to the glenoid. Subscapularis tendon was intact. Blunt dissection
was used to try and mobilize the supraspinatus tendon. I was able to
mobilize it about a centimeter, but this still only got close to the center
of the humeral head. I was not able to get it anywhere near the insertion
site. There was also significant fraying of the tendon and the quality of
it was quite poor. Therefore, I elected to just debride the frayed
fibrinous portion of the supraspinatus and infraspinatus tendons as the
tear was not repairable. After this debridement was completed, the wound
was irrigated and then the fluid removed with suction.

Thank you!

Medical Billing and Coding Forum