superior capsular reconstruction - NAME THE ANATOMY PLEASE

Hey guys
I have gotten just this week 8 emails regarding some terms that you have
to read the operative note to find out the anatomy they are working on.

When it comes to selecting CPT codes you have to know what anatomic
structure they are working on.

Right now I am seeing a lot of creative coding when it comes to 'superior
capsular reconstruction/repair'

Superior = top
capsule = joint area
reconstruction/repair = fixing

You have to know what anatomic structures they are working on and if the
operative note does not name the structures - go to the surgeon and ask for
an addendum.
Seeking reimbursement is not a game - if they can't name what they are
repairing/reconstructing then they should not be asking for reimbursement.

Vagueness only works if you are trying to hide something, seriously.. come
on.... I can't imagine they tell the patient "Oh we are going to do a
superior capsule repair but I can't tell you what that means or the structures
that are needing repair. "

In doing a search for just the term 'superior capsule reconstruction
shoulder':
Arthroscopic Superior Capsule Reconstruction Failed Rotator Cuff Repairs
(http://www.arthrex.com/shoulder/superior-capsule-reconstruction) "The SCR
was pioneered by Dr. Teruhisa Mihata in 2007 for patients with irreparable
rotator cuff tears. "

http://drmillett.com/massive-rotator-cuff-tear-ascr-arthroscopic-superior-ca
psular-reconstruction-procedure/ - ""Patients with “irreparable” rotator
cuff tears or chronic tearing after the reconstruction of massive rotator
cuff injuries may be candidates for Arthroscopic Superior Capsular
Reconstruction (ASCR), a new procedure that can be an option when the rotator cuff
tendon can no longer be repaired."

https://www.theshouldercenter.com/Arthroscopic-Superior-Capsule-Reconstructi
on-Failed-Rotator-Cuff-Repairs - "Patients with large, massive and
previously failed rotator cuff tears that have enough rotator cuff available for
successful mobilization and anatomic repair to the footprint have been
helped greatly utilizing an arthroscopic reinforcement graft technique.."

This is ALL related to cuff issues and we only have ONE arthroscopic RCR
code - or you go unlisted



Margie Scalley Vaught, CPC, COC, CPC-I, CCS-P, MCS-P, ACS-EM, ACS-OR
Auditing, Coding, Documentation and Compliance Consulting
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