If a wound requires a complex repair for one piece of it, plus a graft for the remaining little piece that couldn’t be closed with the complex repair, can you bill both?
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Tag Archives: Repair
Repair of external sphincter muscle
Looking for some CPT coding direction on the following:
Reexploration of the perineal wound with extensive washout with pulse lavage
Reconstruction of external sphincter muscle between 6:00 and 9:00 o’clock position
Additional reconstruction of the anal verge between 6:00 and 8:00 o’clock position
Reexploration of the perineal wound with extensive washout with pulse lavage
Reconstruction of external sphincter muscle between 6:00 and 9:00 o’clock position
Additional reconstruction of the anal verge between 6:00 and 8:00 o’clock position
Condensed report: The previous wound VAC was removed. The wound was the cleansed out extensively with pulse lavage. Significant reduction of edema of the tissues expecially in the perianal area as noted. Close inspection revealed that the external sphincter muscle was transected completely between 6:00 and 9:00 o’clock position. The edges of muscle where debrided and the muscle was approximated with interrupted sutures… Additional sutures were placed between the skin and anal verge to complete repair the area between 6:00 and 8:00 o’clock position. A wound vac was applied.
Appreciate any suggestions for this patient who has been reexplored several times in the past couple weeks from a MVA.
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Biceps tenodesis with humerus fracture repair? 23615 23430
Should the biceps tenodesis (23430) be reported with this ORIF of fractured proximal humerus (23615)? There is no NCCI edit, but I have seen a couple of comments in coding forums stating it would not be separately billed but I’m not sure. One thing that is throwing me off is it looks like a word or two could be missing – "we identified that the biceps tendon and proceeded to perform a bicipital tenodesis…" Not sure what they identified about about the tendon. In any case, I’m hoping someone is familiar with this type of repair – would the biceps tenodesis just be part of the fracture repair or should it be reported? There is no biceps diagnosis- the pre- and post-op dx is just the 4 part displaced proximal humerus fracture.
"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."
Insight: Superior Capsular Reconstruction & Rotator Cuff Repair
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.
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.
Icd 10 pcs repair dural tear
I know for CPT coding when a dural tear occurs during a spinal procedure it is incidental and the surgeon usually will not charge/code for it CPT.
Would I code this procedure though for the ICD 10 PCS? or is it also just incidental and not coded
The surgeon used a Tisseel patch for the dural tear.
thanks
Open subscapularis tendon and rotator cuff repair
Not sure if I am coding these procedures correctly
Operation Performed: Arthroscopy, Labral Debridement, Subacromial Decompression with Open Repair of Subscapularis Tendon, Biceps Tenodesis, and rotator cuff repair, right shoulder
Post operative diagnosis: Full Tear of subscapularis tendon with avulsion, dislocation biceps tendon with a 2.5 cm tear rotator cuff, and impingement syndrome
CPT 23412 [Subscapularis and Rotator Cuff]
CPT 23430 [Biceps Tenodesis]
CPT 29823 [Labral Debridement]
CPT 29826 [Subacromial Decompression]
After the scope procedures, a 4-cm incision was made between the anterior and lateral portals, Subscapularis was completely avulsed, Bed of bone prepared and fixed in 2 row technique. Prior to this biceps tenodesis was done with Arthrex biceps tenodesis Tightrope. Subscapularis was reapproximated with 2 Corkscrew anchors, double armed mattress stitches to take it to the soft tissue fibers which were anterior portion of greater tuberosity. Rotator cuff tear was identified. Bed of bone had been prepared. It was freshened. It was fixed in a 2-row technique. The medial row was 2 corkscrew anchors, double-armed mattress stitches and then 1 Swivelock which gave a watertight closure…
Our doctors are doing a lot of subscapularis tendon repairs and not sure about coding this tendon separately since it is the rotator cuff
Billing for peroneus tendon repair
I would appreciate any help in regards to the surgery performed, as I have minimal experience in podiatry coding.
The procedures performed are
1. Repair of peroneus tendon and groove deepening in the fibula of the peroneal groove, left.
2. Repair of the superior peroneal retinaculum, left
The two CPT codes I came up with to cover the procedures are CPT 27658 and 27675.
Here is the procedure description:
A curvilinear incision was created over the peroneals from just inferior to the tip of the fibula up approximately 2-3 inches superiorly. Bleeders were clamped and ligated. Sharp and blunt dissection was used to gain access to the superior peroneal retinaculum and to the peroneal tendons. The retinaculum was transected with Metzenbaum scissors. Further incisions exposed the peroneal tendons. The peroneus longus appeared to be in good condition without any flattening or signs of tearing. The broadening was debrided with the Metzenbaum scissors, and the tendon was tubularized and held with a running suture of 2-0 Ethibond. The tendon was torn from approximately 1 inch exposed, and a 1/8th drill bit was inserted behind the peroneal retinaculum, creating space within the fibular canal. The tamp was used to deepen the groove in the fibula. The tendons were placed back in to place, and the peroneal brevis tendon was wrapped with a 4×4 cm EpiFlx placental graft. This was secured with a 3-0 Vicryl.
Next, the area was flushed with normal saline, and the superior peroneal retinaculum was repaired with 2-0 Ethibond. Ther area was once again flushed with normal saline and closed in layered fashion with 3-0 Vicryl for subcutaneous tissues, and the skin was closed in a subcuticular manner…
Would the two codes I selected be correct? It seems the 27675 covers the superior peroneal retinaculum repair. Or I may be interpreting that wrong, which is why I would love any help and advice.
TIA
KM
Inguinal Hernia Repair? Need Help with Codes
Hello! I am not sure how to code the below procedure. Any assistance is appreciated 
Excision of meshoma and neurectomy of the Genital branch of the GF nerve. Primary repair of the iatrogenic creation of the fascial defect using a primary suture technique and fascial release.
dx:Left inguinodynia. Cannot exclude recurrent left inguinal hernia. Status post bilateral laparoscopic inguinal hernia repair
thank you
Laparoscopic extraperitoneal repair of ventral hernias with mesh
We have a surgeon that is suddenly doing Lap hernia repairs with retro-rectus posterior component separation or Lap extraperitoneal repair of ventral hernias with mesh. Does anyone know how to code these? Do we bill 49652 & an unlisted 49659? Would this be compared to 15734? Would this be considered part of the repair with mesh? Should we bill 49652 with modifier 22. This has us stumped. I have researched for answers but have not been able to come up with anything for how to code these. Anyone familiar with these? Any help would be appreciated.
Repair of Cystotomy
New to this specialty… Need help please
I have codes 58571/51999
Can’t find a code for Repair of cystotomy
PREOPERATIVE DIAGNOSIS:
Family history and genetic predisposition to ovarian endometrial cancer.
POSTOPERATIVE DIAGNOSIS:
Family history and genetic predisposition to ovarian endometrial cancer.
PROCEDURE:
1. Robotic laparoscopic hysterectomy, bilateral salpingo-oophorectomy.
2. Repair of cystotomy.
3. Diagnostic cystoscopy.
ANESTHESIOLOGIST:
Dr. xxxxx
ANESTHESIA:
General.
FINDINGS:
The patient had normal uterus, tubes, ovaries and pelvis. The cystotomy was
done on the dome of the bladder through dissection of lower uterine segments
and the cervicovaginal junction. This was identified immediately and repaired.
There were no other injuries. There was no bowel injury or ureter injury at
the end of the case. Instillation of saline was done into the bladder at
approximately 500 cc with no bladder leak noticed laparoscopically. Bilateral
jets from the ureteral orifices were present.
BLOOD LOSS:
50 mL.
DRAINS AND PACKING:
Foley catheter.
IV FLUIDS:
A 1000 cc of crystalloid.
URINE OUTPUT:
200 cc of amber urine.
COMPLICATIONS:
Cystotomy.
SPECIMENS:
Uterus with cervix and bilateral uterine tubes and ovaries.
DISPOSITION:
Postanesthesia care unit.
POSTOP CONDITION:
Stable.
DESCRIPTION OF PROCEDURE:
After reading and signed the consent, the patient was brought to the operating
room, where general anesthesia was induced. She was placed in the dorsal
lithotomy position. The abdomen, perineum, and vagina were prepped and draped
in usual sterile fashion. Time-out was called to confirm correct patient
identity and planned procedure. A weighted speculum was inserted into the
vagina after a Foley catheter was placed. The anterior lip of the cervix was
grasped with a single-tooth tenaculum. The uterus was sounded to 8 cm. Stay
sutures were placed at 3 and 9 o’clock and a medium VCare uterine manipulator
was sutured into place. All instruments removed from the vagina. Attention
was paid to the abdomen where a supraumbilical incision was made with a
scalpel, carried down to the fascia which was grasped similarly with Kocher
clamps. This was incised and using blunt entry, the peritoneal cavity was
entered. The Hasson trocar was placed without difficulty under direct
visualization, the right and left 8 mm port and an AirSeal port to the left
were placed with no injuries. The robot was docked. The right arm was curved
monopolar scissors and the left arm was the bipolar Marilyn. In a sequential
fashion and then bilaterally, the infundibulopelvic ligaments were come across
just under the ovary with no bleeding from this pedicle. The round ligament
was taken bilaterally in the anterior leaf and the posterior leaf of the broad
ligament were separated. The bulge was seen and the tissue was cleared from
the anterior surface of the uterus to push the bladder cephalad position but it
was clear that there was approximately 1 cm entry into the bladder. This was
then fixed at this point with 3 layers of 2-0 Vicryl suture with no
complications thereafter. The rest procedure could be completed. The uterine
artery was taken bilaterally when both the anterior and posterior aspects of
the cuff could be seen and following this and the tissue was cleared, colpotomy
was done circumferentially with no difficulties. The cuff was closed with a
V-Loc suture with excellent closure. All pedicles were evaluated. There was
no bleeding as insufflation was released. Attention was then paid to
cystoscopy. The bladder was filled and the pneumoperitoneum was reestablished
only with left gas and the camera placement showed the repair was watertight.
The bladder distended nicely at cystoscopy and there was almost immediately
jets that were stained with fluorescein yellow as given by Anesthesia.
Everything else was removed from the bladder and the diagnostic cystoscope with
saline distention media was removed. The Foley catheter was replaced. The
fascia of the umbilical incision was closed with 0 Vicryl and then the skin
incisions were closed with a 4-0 Monocryl in a running subcuticular fashion.
The patient tolerated the procedure well. There were no complications.
Sponge, lap, needle counts were correct x3. The patient received Cefotetan 2 g
prior to initial incision.