# Arthroscopic AC joint repair



## smitt (Jul 2, 2014)

Patient underwent a arthroscopic AC repair/reconstuction.   I do not find a appropriate code for this procedure.  Any suggestions?


Preoperative Diagnosis:
1.  Acromioclavicular Type 5 dislocation of the left shoulder

Postoperative Diagnosis: same 


Procedure:
1.  Diagnostic arthroscopy left shoulder
2.  Arthroscopic AC joint repair/reconstruction                       


Implants: Arthrex Dog Bone Device

Indications for Operation
Patient presented after he was thrown from his ATV 10 days ago.  Xrays demonstrated a type 5 AC separation.  The patient chose to proceed with the aforementioned procedures.  At no time were any guarantees implied or stated.


Site Marking and Surgical Prep
The patient was seen in the holding area and the appropriate extremity marked with a pen.  Interscalene block was administered by the anesthesia department. The patient was taken to the operative suite, identified, placed on the operating room table in the supine position.  After induction of general anesthesia, the patient was placed in the beach chair position with all bony prominences adequately padded and the head and neck anatomically supported.


Examination  Under Anesthesia.
Full symmetric range of motion, no instability.  The clavicle was reducible.


Diagnostic Arthroscopy
The upper extremity from the neck to fingertips was prepped with chloraprep and draped in the standard fashion.  The forearm was well padded and secured in the Tenet Spider extremity positioning device.  A standard midglenoid posterior portal was established.  The trocar and cannula were inserted.  The trocar was removed and the arthroscope and inflow inserted.  Systematic arthroscopy was performed and the findings are summarized below.


1.  Superior Labrum/Biceps Tendon: Intact, fraying of the rotator interval
2.  Anterior/Posterior Labrum: Intact with anterior fraying
3.  Rotator Cuff: intact
4.  Inferior Axillary Recess:  No loose bodies
5.  Articular Surfaces:  Intact




AC Joint repair/reconstruction


A superior lateral portal was made just above the biceps tendon under direct visualization.  A cannula was placed.  The rotator interval was debrided with the shaver and electrocautery.  The tip of the coracoid was exposed and skeletinized to the base of all soft tissue.  A 70? arthroscope was then placed in the posterior portal to enhance arthroscopic visualization of the base of the coracoid.  This ensure complete coracoid exposure.  


A low anterior portal was then just above the subscapularis tendon.  A size 10 passport cannula was placed in the anterior portal.  The 30 degree scope was then placed in the superior anterior lateral portal.  Through the low anterior portal, the AC drill guide was placed under the coracoid base.  An incision was then made approximately 3 cm medial to the AC joint on the clavicle with a 15 blade.  The subcutaneous tissue was divided down to the deltoid fascia over the clavicle.  The electrocautery was used to open the fascia.  The tissue on the superior aspect of the clavicle was debrided with an elevator.  The center of the clavicle was identified. The clavicle and coracoid tunnels were drilled using a  3 mm cannulated drill.


The trocar was removed from the drill and the suture lasso wire loop was passed through the drill
cannulation loop and retrieved through the low anterior cannula with a grasper. The cannulated drill, leaving only the wire in the tunnels was removed.


The tails of the FiberTape Loop and TigerTape Loop were loaded through the SutureLasso wire loop and  the tails were pulled up through the coracoid and clavicle tunnels. A grasping instrument was used to turn the button sideways and push it through the PassPort Button Cannula. The Dog Bone Button was seated at the base of the coracoid. The concavity was seated against the coracoid and the orientation line was in
line with the arch of the coracoid. The concavity faced the clavicle and the orientation line was in line with the axis of the clavicle.


The AC joint was reduced and the fiber tape limbs were tied over the button with four alternating half-hitches. The AC joint reduction was confirmed with c arm fluoroscopy after tying the first
knot and after confirmation then the second fibertape was tied. The suture limbs were cut to complete the repair.


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## nyyankees (Jul 9, 2014)

smitt said:


> Patient underwent a arthroscopic AC repair/reconstuction.   I do not find a appropriate code for this procedure.  Any suggestions?
> 
> 
> Preoperative Diagnosis:
> ...



Unlisted 29999 works and I would compare to 23550. Good luck


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