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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

Medical Billing and Coding Forum

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

Medical Billing and Coding Forum

Hand/Fingers – Excision cyst (tendon sheath), Excision Osteophytes (phalanx)

I would greatly appreciate help with references for the following operative scenario. I have been given codes, 26160 and 26110 (these bundle), I find references that suggest use of 26160 (excision of cyst off tendon sheath) and 26236 (osteophyte removal).

For the operative case below would it be considered over-coding to code: 26235, f7; 26236, 51, f7; 26160, 59, 51,f7

I have researched myself to the point of total confusion – thank you to those more experienced than me and taking time to help a fellow coder out !!

TECHNIQUE:
Patient was taken to the operating suite and after the induction of adequate general anesthetic the right upper extremity was prepped and draped in the usual sterile fashion. An Esmarch was used to exsanguinate the limb and the tourniquet was inflated to 250 mmHg. At this point in time an L shaped incision was made over the distal aspect of the right long finger have a large 1.5 x 1.5 cm lesion consistent with probable mucoid cyst. A radially based flap was elevated and dissection was carried down to the extensor sheath. There was a complex multi lobulated cystic lesion that was carefully excised off the extensor insertion and distal interphalangeal joint capsule radially. This was sent for pathologic identification. We carefully retracted the extensor mechanism and perform a distal interphalangeal joint arthrotomy with debridement of large dorsal osteophytes of both the base of the distal phalanx and the head of the middle phalanx. This was all sent for pathologic confirmation. The wound was then thoroughly irrigated. It was loosely closed with 4-0 nylon. Xeroform, 4 x 4’s, and a compression wrap was applied to the right long finger. The patient tolerated this procedure well and went to recovery room in stable.

Medical Billing and Coding Forum

Excision of Achilles tendon

Hi everyone,

I am looking for a code for the excision of the Achilles tendon, it was not repaired. Also the plantaris tendon was also excised. Not sure if it would be an unlisted code.

Attention was directed to the left posterior leg where there is an open wound with exposed Achilles tendon. The entire Achilles tendon was resected at least 1-2 cm proximal and distal to the open wound until healthy bleeding was noted within the tendon and there is normal tendon fibers. We essentially had to resect the Achilles tendon off the level of the calcaneus distally and then undermined the wound proximally to resect the proximal 2 cm. Healthy bleeding was noted underneath the tendon. The entire tendon was nonviable. It was sent for pathological examination. A posterior compartment fasciotomy was then performed to expose the flexor hallucis longus muscle belly which was necrotic and nonviable. This portion of the muscle belly was then removed. Plantaris tendon was also removed as it was infected and nonviable. A thorough flush was then performed with 3 L normal saline. After hemostasis was maintained we then applied the Integra biologic skin graft. It was unstable to the wound

Thanks

Medical Billing and Coding Forum

Exploration Peroneal Tendon

Provider was planning on doing a peroneal tendon repair. Once the incision was made, he could not find the tendon stumps, and found the tendons were greatly retracted. After performing a detailed exploration and doing no repair or debridement whatsoever, the patient was closed up. No tendons were harvested, no allograft was placed, and the provider decided this would have to be a two stage procedure. I can not find an exploration code at all, and Im wondering if I should bill 27675 with a -52 modifier? Any help is appreciated!

Medical Billing and Coding Forum

Inspection of Long Head Biceps Tendon

Hello

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.

Medical Billing and Coding Forum