Am I understanding this or am I way off…
Want to code this way: 23410-LT 29828-59, 29826-59 and 29823. Not use 29820
29828, 29826 29823 (NCCI edit Presence of an anatomic site modifier on this code(s) 23410 is suppressing NCCI edit. Check documentation to determine whether both code pair(s) can be billed or an additional site modifier added)
29820 (NCCI Edit.. Code 2 of a code pair with 29828 29823 that would be allowed if an approp. NCCI modifier were present.)
DX: Acute massive RTC tear, bicep tenosynovitis, labral fraying with impingement, synovitis of the glenohumeral joint
Surgery: Arthroscopy left shoulder w/extensive debridement of the labrum, partial synovectomy, subacromial decompression with acromioplasty with bicep tenodesis and open acute roatator cuff repair
PROCEDURE:
introduced the trocar into the glenohumeral joint atraumatically and began a diagnostic arthroscopy, which demonstrated a
massive rotator cuff tear, biceps tenosynovitis with a torn labrum at the biceps insertion synovitis through the shoulder.
I performed a biceps tenotomy, which was later repaired. I debrided the stump of the biceps, utilized a shaver to circumferentially debride the labrum, and then utilized a Werewolf RF to perform a partial synovectomy of the glenohumeral joint. Once completed, I then placed the scope into the subacromial space. I started a standard anterior lateral portal and with the use of a Werewolf and shaver,
performed a subacromial decompression and bursectomy. I then identified a large spur on the acromion and performed an acromioplasty with a burr, co-planing it with the AC joint. Once completed, I then made the decision to open the rotator cuff. I then extended my
anterior lateral portal superiorly and slightly inferiorly, dissected down through the subcutaneous tissue with scissor dissection and elevated medial and lateral flaps over the deltoid fascia and then split the deltoid and the raphe between the anterior and lateral delts. I then placed a Link retractor. I identified the bicipital groove by externally rotating. I incised the transverse ligament and the pulled the biceps through the incision. I then placed a 1.8 mm Q-Fix anchor at the top of the bicipital groove. I rasped the entire groove and then whipstitched the biceps tendon with the suture from the Q-Fix. I reduced it within the bicipital groove and then tied knots over the top. I then utilized
the remaining suture to repair the transverse ligament. I then identified the massive rotator cuff tear. I debrided the insertion with a rasp and rongeur and got down to a bed of good bleeding bone and then placed three 5.5 Healicoil suture anchors along the articular margin. Each one had good bite. I then sequentially passed all twelve sutures through the rotator cuff in standard fashion. I then reduced the cuff down to the insertion and tied medial row knots. I then placed one suture from each one of the knots in an anterior lateral 5.5 mm MultiFIX-S Ultra suture anchor for my lateral row, reduced the cuff back down to the insertion very well and then repeated those same steps with the
more posterior lateral 5.5 MultiFIX-S Ultra. Overall, I was extremely happy with the reduction of the rotator cuff and the overall repair. I then thoroughly irrigated out the wound. I documented the repair with a picture and then closed the deltoid fascia with running #0 Vicryl. The subcutaneous layer was then closed with a #2-0 Vicryl and the anterior and lateral portals were closed with #3-0 nylon. I then dressed the lateral wound with Dermabond, Steri-Strips, Xeroform, 4x4s, ABDs, and Medipore tape. The patient was placed in an UltraSling, an Iceman was applied, and he was taken to PACU in stable condition.