New to Ortho - please help.

Hello Fellow Coders:

I am posting charges, my doc says codes should be 29827, 29826, 29825, 29824, 29823. I feel the codes should be 29827, 29826-51. Can someone give me something insight am I missing something? Thanks for any help. I don't want to challege my new boss I just want to do code correctly.

OPERATIVE NOTE:

After informed consent was received from the patient, she was brought back into OR #2, and the patient was placed on the OR table. She was placed under successful general anesthetic after she was placed into a modified beach chair position with careful positioning of the head, neck, and all four extremities.

At this point a posterior arthroscopic portal was established inferomedially to the posterolateral corner of the acromion. Via a 1-cm established incision, the scope was gently placed into the glenohumeral joint, and an anterior portal was then established using an 18-gauge spinal needle to confirm the position of the rotator cuff interval. Through this interval, the 5-mm Accuflex camera was then brought into the shoulder, and the contents of the shoulder were carefully and systematically explored. The articular surface of the supraspinatus appeared to be intact, although when I ran an 18-gauge spinal needle through this area to run 0 Prolene through this and out through the anterior portal, I could tell that there was less resistance to the bevel of the needle, consistent with a high-grade partial tear of the supraspinatus at its insertion. I then carefully explored the glenoid labrum, biceps anchor, the biceps itself, as well as the remainder of the rotator cuff and joint surfaces. As I explored the glenoid joint surface, I identified a small area of pathology along the anteroinferior glenoid where there appeared to be a small 1-mm cleft right at the anteroinferior glenoid between the glenoid itself and the glenoid labrum. The labrum itself was probed with a nerve hook and was noted to be quite stable, but the cartilage off the anteroinferior humeral head had been sheared and was somewhat fragmented in a stellate-like laceration involving maybe a 10 x 5-mm area along the anteroinferior glenoid. This cartilage had been peeled off the bone, and multiple small flap tears were identified. Because of the fact that these were pulled up on three sides, I elected to gently debride this area with a 4.5 shaver and easily was able to remove this cartilage. There was raw bone exposed underneath this, so I took the microfracture set and placed two or three holes into this small area of the glenoid in hopes that we could get some blood supply back to this area and at least get some fibrocartilage healing.

At this point, the scope was placed into the subacromial bursa, and a lateral portal was then established using an 18-gauge spinal needle. At this point, the ArthroCare wand was placed in the 5-mm access cannula into this lateral portal through a 1-mm stab incision, and the coracoacromial ligament was released off the anterior acromion shelf while protecting the anterior deltoid. The inferior capsule was released off the AC joint, and the AC joint was noted to have some degree of degenerative changes. Since she was tender preop and since x-rays seem to demonstrate a small osteophyte off the inferior clavicle laterally, there was enough evidence for me to be concerned that some of the patient’s pain may be emanating from the AC joint. I then elected through the anterior portal to take my 5.5 stonecutter bur and gently perform a distal clavicle excision removing the distal 5 to 7 mm of bone. I should note also that an anteroinferior acromioplasty was performed converting the acromion into a type 1 acromion with a 5.5 stonecutter bur.

Lastly, I turned the scope down to the rotator cuff, and I could identify where the blue Prolene was entering this area. Using the 4-mm blunt trocar, I could easily push through a very soft area in the rotator cuff, consistent with a high-grade partial tear, which was intertendinous.

At this point, the Opus suture anchor device was brought up on the table and using the M-connector, an inclined mattress suture was then placed in the lateral stump of the supraspinatus tear, after I gently decorticated its greater tuberosity insertion with a 4.5 shaver. I then placed the slotted cannula into the field, shuttled my sutures through the cannula out to the slots, and then used a T-handle awl to create a hole off the lateral footprint of the greater tuberosity. I then was able to repair the rotator cuff anatomically without difficulty by placing the sutures through the anchor then bringing the anchor into the hole created by the T-handle awl and tightening the sutures down onto the decorticated part of the greater tuberosity, resulting in an anatomic repair. The wound was then copiously irrigated.

Final photographs were obtained of the distal clavicle excision and rotator cuff repair, as well as the microfracture technique, and the patient’s three portal wounds were then repaired with varied 4-0 Monocryl. The patient was placed in a minimally compressive dressing, placed in a sling,

extubated, placed supine, awakened, and brought to recovery in stable condition. Detailed verbal and written discharge instructions were then given to the patient’s partner.

Blood loss was less than 2 cc. Sponge and needle counts were correct.

re: New to Ortho - please help.

I would say;

29827
29824-51
29826-51
29823-51

CCI edits show 29825 is included in 29827 and 29823