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Tag Archives: Tenotomy

3 part distal radius ORIF WITH tenotomy of brachioradialis

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Our provider is performing a tenotomy of the brachioradialis tendon (CPT 25290) during an ORIF of a distal radius fracture (CPT 25609) He is using the same fracture diagnosis on both the ORIF and the tenotomy.

Documentation:
"due to the pull of the brachioradialis , it was not possible to reduce the fracture. Therefore, a brachioradialis tenotomy was performed.", or

" brachioradialis tenotomy was performed in a subperiosteal fashion to allow radial styloid manipulation"

Although there are no bundling edits on these codes, it is my feeling that this is would be part of the ORIF approach, and not separately reportable.

Am I right in saying this?

Medical Billing and Coding Forum

Arthroscopic Biceps Tenotomy

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I know that Arthroscopic Biceps Tenotomy is coded as CPT 29822 (limited debridement). The surgeon also performed Arthroscopic Rotator Cuff Repair, AC joint resection and Subacromial decompression & acromioplasty. I know that with the limited debridement, it can’t be coded separately per the NCCI edit. Can the 29822 for Biceps tenotomy be billed separately?

Medical Billing and Coding Forum

is an arthroscopic biceps tenotomy inclusive to extensive debridement

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We were just told by our State Labor and Industries review department for prior authorization (Qualis) that per AAPC Coding guidelines, and arthroscopic biceps tenotomy (CPT 29999 compared to 23405) is inclusive to an arthroscopic debridement (29823), however, according to AAOS, these are not inclusive codes as well as looking at the NCCI guidelines Ch 4 section E subsection 7 –

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!!!!

Medical Billing and Coding Forum

Gastroc Recession and Soleus Tenotomy

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Hello

How would you code a gastroc recession and soleus tenotomy through the same incision?

At this point, as the patient had restriction of her dorsiflexion, an incision was made in the posterior calf and the peritenon exposed while protecting the sural nerve and vein. The gastrocnemius was lengthened in the manner of Strayer. Through the same incision a tenotomy was also done of the soleus. This allowed twenty degrees of dorsiflexion. The wound was closed in layered fashion while protecting the sural nerve and vein.

I was thinking 27687 (gastroc) and 27685 (soleus) but wasn’t 100% sure.

Thanks in advance.

Medical Billing and Coding Forum

Tenex vs Tenotomy

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I have a provider who is performing Tenex procedures, but has been coding them as a tenotomy. From what I understand this is not correct, and should be using an unlisted code.

Under procedure performed he states, "percutaneous tenotomy of common extensor tendon using ultrasound guidance to cut and remove the patient’s pathologic tissue."

Under description of procedure he states, "Once I confirmed the tip was directly in the pathologic tissue, the foot pedal was depressed and the tendon was incised along its length cutting and removing the diseased tendon and tissue. Once I confirmed all tissue was removed, I did a quick post scan to ensure there was no remaining tissue including PDI for neovascularization which appeared to be completely resolved."

Thanks for any help you guys can provide!!

Medical Billing and Coding Forum

Biceps tenotomy

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Wow. I am finding many differences of how to code for an arthroscopic biceps tenotomy during shoulder arthroscopy. I cannot seem to make sense of it all. Or find a conclusive, agreed upon, coding solution. Does anyone have any recent and up-to-date information?

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…..

Medical Billing and Coding Forum

Tenotomy performed in wound care clinic

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I am struggling with a diagnosis code that will show the reason for a tenotomy that was performed in a wound clinic setting. The patient has a toe ulcer on the left second toe and she has a hammertoe next to the second toe that is putting pressure on the wound. The physician performed a tenotomy to allow the hammertoe to straighten discontinue rubbing the wound. I would appreciate any help you can give me.

Medical Billing and Coding Forum | AAPC