Rotator Cuff Repair (Arthroscopic)

CPT 29827
Approach Arthroscopic
Add-on / Variant CPTs
  • 29826 — Arthroscopy, shoulder, with acromioplasty
  • 29828 — Arthroscopy, shoulder, with biceps tenotomy/tenodesis
Preoperative Diagnosis:

Right [left] [full-thickness / partial-thickness] rotator cuff tear, [supraspinatus / infraspinatus / subscapularis], confirmed on MRI

Postoperative Diagnosis:

Same

Procedure Performed:

Right [left] arthroscopic rotator cuff repair, [single-row / double-row / transosseous equivalent] technique [with acromioplasty / biceps tenotomy or tenodesis]

Attending Surgeon:

[Attending name], MD/DO

First Assistant:

[Resident/PA name]

Anesthesia:

General endotracheal with interscalene nerve block

Indications:

The patient is a [age]-year-old [male/female] with a [full-thickness / partial-thickness] rotator cuff tear confirmed on MRI, presenting with refractory shoulder pain and weakness after [X weeks/months] of conservative management including physical therapy. The risks, benefits, and alternatives were discussed and informed consent was obtained.

Findings:

Arthroscopic examination of the glenohumeral joint demonstrated a [X]-cm [full-thickness / partial-thickness] tear of the [supraspinatus / infraspinatus] at the [footprint / musculotendinous junction]. The tear was [mobile / retracted to the glenoid rim] with [minimal / moderate / significant] muscle atrophy on pre-operative MRI. The biceps tendon was [normal / frayed / with SLAP tear]. The subscapularis was intact. The articular surface was [intact / with Grade [II–IV] changes at the humeral head / glenoid].

Description of Procedure:

The patient was positioned in the [lateral decubitus / beach chair] position with the operative arm in [traction / supported]. Standard posterior viewing and anterior working portals were established. Diagnostic arthroscopy was performed.

The subacromial space was entered through the posterior portal. Bursectomy was performed to visualize the rotator cuff tear. The tear was characterized: [X] cm in [AP / ML] dimension. Tear edges were prepared with a shaver and electrocautery. The footprint was decorticated with a burr to create a bleeding bone surface.

[Acromioplasty was performed: the anterior-inferior acromion was resected with a [4.5-mm] burr to Type I shape.]

[Single-row repair:]
[X] [5.5-mm] suture anchors were placed at the medial footprint. Each anchor was loaded with [2 suture pairs]. Sutures were passed through the tendon using a suture passer and tied arthroscopically with [Samsung Medical / Weston] knots.

[Double-row / transosseous equivalent repair:]
Medial anchors were placed at the articular margin. Suture limbs were passed through the tendon. A lateral row of [4.75-mm] knotless anchors was placed at the lateral footprint, compressing the tendon to the greater tuberosity in a mattress configuration.

[Biceps tenotomy / tenodesis was performed: the biceps was released from the superior labrum. [Subpectoral tenodesis was performed with a [30-mm] interference screw.]]

Final arthroscopic views confirmed anatomic repair with secure anchor fixation and tendon coverage of the footprint. Portals were closed with [3-0 Monocryl]. A sling was applied.

Complications:

None

Specimens:

None

Estimated Blood Loss:

Minimal

Drains:

None

Disposition:

The patient was taken to the PACU in stable condition in a sling. Weight-bearing of the operative arm was restricted. Physical therapy with passive range of motion was to begin at [6 weeks]. Return-to-activity protocol was discussed.

Epic SmartPhrase Version 
PREOPERATIVE DIAGNOSIS: Right/Left *** rotator cuff tear, ***
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Right/Left arthroscopic rotator cuff repair, *** technique
ATTENDING: ***, MD/DO
ASSISTANT: ***
ANESTHESIA: General + interscalene block

INDICATIONS: .PTAGE-year-old .PTSEX with *** rotator cuff tear, failed conservative management. Consent obtained.

FINDINGS: *** cm full/partial thickness tear, supraspinatus/***. Biceps ***. Subscapularis intact. Articular surface ***.

PROCEDURE:
*** position. Posterior/anterior portals. Diagnostic scope: findings above. Subacromial entry. Bursectomy. Tear characterized *** × *** cm. Footprint debrided and decorticated. [Acromioplasty to Type I.] Medial row: *** × *** mm anchors, sutures passed, tied. [Lateral row: knotless anchors.] [Biceps ***]. Final scope: anatomic repair, footprint covered. Portals closed. Sling applied.

EBL: Minimal
COMPLICATIONS: None
DISPOSITION: Sling, passive ROM at 6 weeks, activity protocol reviewed.

Signed: .ME, .MYDEGREE
.TODAY
Variants

Partial-Thickness Tear: Transtendinous Repair

The articular-sided partial-thickness tear involved [>50%] of the tendon thickness. Given the extent of tearing, in-situ repair was performed. The bursal surface was incised to convert the partial tear to a full-thickness defect to permit suture anchor repair. Alternatively, a transtendinous technique was used with anchor placement from the articular side without completing the tear. Partial tears involving <50% of tendon thickness were debrided and acromioplasty performed without repair.

Subscapularis Tear Repair

A full-thickness [/ partial-thickness upper third] subscapularis tear was identified. The subscapularis tendon was mobilized by releasing the comma sign tissue and coracohumeral ligament. The lesser tuberosity footprint was decorticated. [2] medial row anchors were placed, sutures passed through the subscapularis with a 45° suture passer, and tied. Subscapularis tears are often missed on MRI and require systematic evaluation at arthroscopy with the arm in external rotation and the biceps sheath examined.

Charting Tips
  • Document tear size in two dimensions (AP and ML). Tear size drives repair technique selection and prognosis. Massive tears (>5 cm) and irreparable tears have distinct management and should be classified using Cofield size criteria.
  • Document anchor number, size, and position. Suture anchor purchase failure and re-tear are the most common complications. The number of anchors, their anatomic position (medial vs. lateral row), and suture configuration should be documented.
  • Document the fatty infiltration and atrophy grade from pre-operative MRI (Goutallier classification). Grade III/IV fatty infiltration predicts poor healing potential and should be documented to set expectations and justify repair vs. debridement-only.
Billing Tips
  • Bill 29827 for arthroscopic rotator cuff repair (15.20 wRVU, 90-day global). This is the standard code for arthroscopic cuff repair regardless of tear size or number of anchors used.
  • Bill 23410 for open repair of acute rotator cuff tear (11.11 wRVU). Bill 23412 for open repair of chronic tear (11.63 wRVU). Open codes have lower wRVU than arthroscopic 29827, so ensure the approach matches the code billed.
  • Concomitant biceps tenodesis (23430, 4.95 wRVU) or tenotomy (23405, 3.38 wRVU) is separately billable with modifier -51 when performed at the same setting. Document biceps tendon status and treatment.
  • Subacromial decompression/acromioplasty (29826, 7.91 wRVU) may be separately billable with modifier -51 when performed in addition to cuff repair. Confirm payer policy, as bundling rules vary.
  • 90-day global period: sling management, physical therapy initiation, and routine follow-up are bundled. PT sessions are billed by the therapist independently. Document the prescribed rehabilitation protocol in the discharge instructions.