Orthopedic Coding Questions June 21, 2012-06-06
Question
1.
Code the appropriate procedure. Endoscopic anterior and posterior capsule labrum
reconstruction with removal large loose body, labrum chondroplasty, glenohumeral
debridement.
Answer:
Arthroscope is a type of endoscope. You code 29806 (Arthroscopy, shoulder, surgical;
capsulorrhaphy) for the Bankhart/labrum reconstruction and 29819 (Arthroscopy, shoulder,
surgical; with removal of loose body or foreign body) for the removal of loose body
IF the loose body is 5 mm or greater. (per AAOS) The chondroplasty and
debridement are bundled in 29819.
2.
Answer:
Massive complete rotator cuff, markedly retracted, irreparable very retracted
atrophied and unable to be repaired. Scope was unable to advance and the greater
tuberosity was large and irregular, removing soft tissue and bone from this area. The
subacromial space is decompressed; we left the CA ligament intact, removed inferior
spurring and debris. The bursa was debrided. This was also non-mobile. AC joint
outlined with a light wave and then a burr was utilized to remove 1cm of the distal
clavicle.
A. How many independent procedures were performed?
B. Give the CPT Codes.
A. Three separate and distinct procedures were performed.
B. 29824 Arthroscopic Clavicular Resection, 29822-59 Arthroscopic Shoulder
debridement limited and 29826 Arthroscopic Subacromial Decompression with
Acromioplasty
3. DIAGNOSIS: Septic arthritis, right elbow.
PROCEDURE: Irrigation and debridement of septic bursitis right elbow with a
complete en bloc excision in entirety of the olecranon bursa as well extensive
debridement of the deep abscess tracking proximally along the triceps musculature
for length of 10 cm and tracking distally along the volar and dorsal musculature and
subcutaneous tissue approximately 20 cm. Give the appropriate CPT CODE.
Answer:
24105 only. 23930 is inclusive of 24105.
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4. DIAGNOSIS: Right wrist dislocation status post reduction now with avascular
necrosis of scaphoid and lunate and severe contracture. Severe contracture of index,
middle, ring, and small finger secondary to complex pathology including Scarring of
extensor mechanism, contracture of the PIP joint and contracture of intrinsic
mechanism.
Procedures Performed:
Right wrist proximal row corpectomy
RT wrist extensor tendon extensive tenosynovectomy and tenolysis
RT index finger proximal interphalangeal joint capsulotomy and release of collateral ligament
RT index finger extensor mechanism tenolysis
RT index finger distal intrinsic tendon release
RT middle finger extensor tendon tenolysis
RT Middle finger distal intrinsic tendon release
Rt Middle finger PIP joint capsulotomy
Rt. Ring finger extensor tendon tenolysis
RT ring finger PIP joint capsulotomy
RT ring finger distal intrinsic release
RT small finger extensor tendon tenolysis
RT small finger proximal interphalangeal join capsulotomy
RT small finger distal intrinsic release
Given the procedure mentioned above:
A. How many independent procedures were performed?
B. Give the CPT Codes.
Answer:
A. Nine separate and distinct procedures were performed.
B. 25215 RT Corpectomy; all bones of proximal row
AAOS Codex 2012 states included in this code would be arthrotomy with
synovectomy (such as 25118)
26525x4 Capsulectomy or capsulotomy; interphalangeal joint, each joint -- For the Index
finger; Middle Finger; Ring finger; Small finger
AAOS Codex 2012 states included in this code would be release of the collateral
ligament/volar plate; incision of tendon sheath; arthrotomy; manipulation of IP joint
26445x4 Tenolysis, extensor tendon, HAND OR finger, each tendon -- for the Index finger;
Middle finger; Ring finger; Small finger
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5. DIAGNOSES: Right foot hallux rigidus. Second, third, and fourth claw toe deformity.
Extensor digitorum longus and brevis contracture, second toe metatarsophalangeal joint
GIVE THE FOLLOWING CPT FOR PROCEDURE PERFORMED.
a. Great toe proximal phalanx dorsal closing wedge osteotomy.
b. First metatarsophalangeal joint cheilectomy, removal of loose body and extensive capsule
release and chilectomy.
c. Second toe extensor digitorum longus lengthening with arthrotomy and collateral ligament
release of second metatarsophalangeal joint.
d. Distal condylar excision, proximal phalanx, second toe, with interposition arthroplasty.
e. Third, fourth and fifth toe flexor digitorum longus to extensor digitorum longus tendon
transfer.
Answer:
CPT 28289 Hallux rigidus correction with cheilectomy, debridement and capsular release of
the first metatarsophalangeal joint --for the great toe;
CPT 28285 x 4 Correction, hammertoe (eg, interphalangeal fusion, partial or total
phalangectomy) ---for the second toe (procedures C and D) as well as third fourth and fifth
toe.
NOTE: 28234, Tenotomy, open, extensor, foot or toe, each tendon, is included when
coded with 28285. In addition with, extensor tenotomy and repair (28208, 28234)
are inclusive of 28285.
CPT 28270 Capsulotomy; metatarsophalangeal joint, with or without tenorrhaphy, each joint
(separate procedure) ---for the second MTP joint
CPT 28153: Resection, condyle(s), distal end of phalanx, each toe – is reported for distal toe
(procedure d)
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