# Arthroscopic AC joint reconstruction



## Lisa Bledsoe (Jul 18, 2008)

I'm lost...
Surgeon performed a right shoulder arthroscopy with labral repair (29807); distal clavicle excision - open (23120); *and arthroscopic AC joint reconstruction with allograft tendon - WHAT CODE?*


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## trose45116 (Jul 18, 2008)

you are going to have to use and unlisted code for this 29999 would be the code. there is not an arthoscopic code for that. correct me if im wrong on this.


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## mbort (Jul 18, 2008)

He/she didnt do "any" of it through the open incision? I hate unlisted codes but you may be stuck on this one.  Can you post the op note?


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## Lisa Bledsoe (Jul 18, 2008)

I'll have to type it in...

Attention was first turned to the labrum which was elevated and the remainder from the anterior surface of the glenoid superiorly.  A bleeding bony trough was then created with the use of an oscillating shaver.  Three Bio-Suture Tak anchors were placed one superiorly and two anteriorly to facilitate repair and reapproximation of the labral tissue.  There was a small 10% fraying of the biceps tendon, which was simply debrided.

Attention was then turned to the anterior capsule.  A synovectomy was performed anteriorly anterior to the labral repair exposing the inferior  surface of the coracoid at its base.

A dorsal incision was then made along the distal third of the clavicle taken sharply through the skin and subcutaneous tissue.  The distal end of the clavicle and AC joint was identified and the distal 5-6 mm of the clavicle excised sharply with an oscillating saw.  The dorsal edge was gently beveled with a saw as well.  Approximately 3.5 cm from the tip of the clavicle, a drill hole was then made to guide the offset guide to the coracoid.  This was then placed under direct visualization  to the inferior surface of the coracoid at its midline base.  A guide pin was then advanced throught the clavicle bicortically and through the coracoid bicortically into the central aspect at the base.  This was then over reamed with a 6-mm reamer under direct visualization.  The guide pin was withdrawn leaving the drill bit in place and a suture passer was then placed through the drill bit.  This was then used to facilitate passage of the previously prepared graft.  The graft had been prepared on the back table.  An allograft folded over the EndoButton loop in its proximal margin and secured.  The distal ends of the graft were then whipstitched with a #2 FieberWire suture.

The graft was then passed with the button under direct visualization and tension from the arthroscopic position until the button was visualized within the subcoracoid space.  The button was then flipped and appropriately positioned and the graft tensioned.  With dorsal pressure on the distal clavicle, the clavicle was reduced and the dorsal button synched down to the dorsal surface of the clavicle.  This was then tied and secured.  The grafts were then appropriately tensioned and secured using a 6-mm interference screw.  The surrounding fraft remainders were trimmed and flushed with the dorsal surface of the clavicle....and then it's closed (I'm tired of typing).

Does it sound open to you all?  It kind of does to me now that I typed it all...


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## mbort (Jul 18, 2008)

yes it sounds open to me.  Once he made the incision for the distal clavicle, he never mentions the scope again. 

nice transcription job  

Mary


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## Lisa Bledsoe (Jul 18, 2008)

Thanks  
I would not want to be a transcriptionist!

So would you code this 23550, 23120-51, 29807-59?

Lisa


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