# Shoulder experts



## ASC CODER (Oct 27, 2010)

posterolateral arthroscopy portal. I was able to enter the shoulder joint with a blunt cannula and trocar. I used the anterior superior viewing portal made with the 18-gauge needle to confirm the trajectory, and then with a small stab incision in the skin. This allowed me to gain access with the small cannula using the ArthroWand and shaver. Immediately, I noticed a large superior labral tear with attachment of the superior labrum and the peel back mechanism noted, and detachment of the biceps anchor. The labral tear extended anteriorly down to about the 3 o'clock position, with complete detachment. I was able to use the shaver to help delineate the remaining viable anatomy. I did trim this all down to stable peripheral rim of the labral tissue, including the superior aspect and the posterior superior portion, which was torn to about the 11 o'clock position. I obtained pictures of the inferior labrum, showing how there was really a hypoplastic labral tissue noted on the inferior aspect of the labrum, and that her shoulder was easily mobilizable and subluxable inferiorly. 

The biceps tendon was tenotomized at this point to help to trim back the labral tissue to a stable peripheral rim. I was able to use a combination of biters and shavers to help to trim this back to a stable rim. I then visualized the rotator cuff, which was noted to be intact, even through internal and external rotation of the arm. 

At this point, we suctioned the shoulder completely dry. I was able to advance with the cannula and trocar up into the subacromial space, where I was able to visualize purulent bursal material. I used the direct lateral portal to help me to remove this bursal tissue and visualize the rotator cuff. I did use a sweeping fashion with the shaver to help me to get the bursal tissue off of the rotator cuff around in the subdeltoid region, especially in the anterior and posterior aspect, and back to the musculotendinous junction. I viewed the inferior aspect of the AC joint and noted there was no evidence of prominent spurs or hyperplastic tissue in this area. 

29823 and 29999 for the arthro tenotomy it wasn't specified that it is a slap and nothing was repaired......opinions


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## bethh05 (Oct 28, 2010)

I am not a shoulder expert, but I agree with 29823 and 29999. What about 29826-52 for the removal of bursa from the subacromial space?


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## ibrcc (Oct 28, 2010)

*"The biceps tendon was tenotomized at this point to help to trim back the labral tissue to a stable peripheral rim."* 
The biceps tenotomy is included in the extensive debridement procedure, 29823, as well as the bursectomy in the SA space.

April 2004 Bulletin (AAOS online)

By Robert H. Haralson III, MD, MBA, Richard Friedman, MD, and Margie Scalley Vaught, CPC, CCS-P, ACS-OR, MCS-P

Synovectomy vs. debridement 
To support a complete synovectomy (29821) or *extensive debridement (29823), the documentation should support work in BOTH the front and back of the shoulder*. 

29823 only.


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## ASC CODER (Oct 29, 2010)

Thank you very much


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## bethh05 (Oct 29, 2010)

The labrum, where the debridement was performed, is in the glenohumeral joint space and the bursectomy was performed in the subacromial space.You can code the bursectomy in the SA joint with extensive debridement of the labrum. Also as far as the tenotomy, that is a cutting or division of the biceps tendon. I am not sure that would be included in the debridement of labrum? Although the op note states this was performed to help trim back the labral tissue. Any other thoughts?


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