A young female patient was taken to the operative suite and was placed under appropriate anesthesia. She has been suffering from pain and a potential rotator cuff tear of the right shoulder. The right arm was sterilely draped and prepped. Arthroscopic portals were created anteriorly-posteriorly. The joint line was carefully examined. The biceps insertion was noted to be normal. The middle and inferior glenohumeral ligaments were visualized and noted to be normal. The undersurface of the rotator cuff was clearly visualized and also noted to be normal. There was a large anterior spur formation. The burr was introduced through a lateral portal and the anterior lip of the acromion was resected. The undersurface of the clavicle was noted to be quite prominent and part of the impinging process. There was intense bursitis and a bursectomy was performed, allowing for acromial decompression and release. Spurs were debrided from the distal clavicle. All instruments were removed, skin incisions were closed and a dressing was applied. The patient was placed in a sling and returned to the recovery room. What CPT® code(s) is/are reported? a. 29822-RT, 29826-RT b. 29824-RT, 29826-RT c. 23415-RT d. 23130-RT, 23120-51-RT
Question
A young female patient was taken to the operative suite and was placed under appropriate anesthesia. She has been suffering from pain and a potential rotator cuff tear of the right shoulder. The right arm was sterilely draped and prepped. Arthroscopic portals were created anteriorly-posteriorly. The joint line was carefully examined. The biceps insertion was noted to be normal. The middle and inferior glenohumeral ligaments were visualized and noted to be normal. The undersurface of the rotator cuff was clearly visualized and also noted to be normal. There was a large anterior spur formation. The burr was introduced through a lateral portal and the anterior lip of the acromion was resected. The undersurface of the clavicle was noted to be quite prominent and part of the impinging process. There was intense bursitis and a bursectomy was performed, allowing for acromial decompression and release. Spurs were debrided from the distal clavicle. All instruments were removed, skin incisions were closed and a dressing was applied. The patient was placed in a sling and returned to the recovery room. What CPT® code(s) is/are reported? a. 29822-RT, 29826-RT b. 29824-RT, 29826-RT c. 23415-RT d. 23130-RT, 23120-51-RT
Solution
The correct CPT® code(s) to report for this procedure would be 29824-RT, 29826-RT. This is because the procedure described involves an arthroscopic distal clavicle excision (29824) and an arthroscopic acromioplasty (29826), both performed on the right side (RT).
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