# Shoulder Arthroscopy decompression paralabral cyst



## pinnaclephyserv

Can anyone help me with this code??

Shoulder Arthroscopy decompression paralabral cyst
Superior labral repair with posterior superior labral and debridement of anterior and inferior labral tear.....

thanks,

pps


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## trose45116

can you post the scrub version of the op note


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## pinnaclephyserv

PROCEDURE PERFORMED:  Left shoulder arthroscopy decompression paralabral cyst, superior labral repair with posterior superior labral repair, and debridement of anterior and inferior labral tear.




Appropriate antibiotics were given intravenously prior to starting the case.  He was carefully placed and allowed to keep his position with left shoulder facing upwards.  Examination under anesthesia demonstrated full range of motion of the left shoulder, which was stable throughout the testing.  All bony prominences were well padded.  The left shoulder and upper extremity were prepped and draped in a regular sterile fashion.  A standard posterior and anterior and superior portal was created.  Diagnostic arthroscopy demonstrated some mild fraying of the rotator cuff tendon from the articular side.  This represents approximately 5% to 10% thickness of the rotator cuff tendon.  This was debrided with 4.0 full-radius resector.  There was also fraying of the anterior and inferior labral structures.  This was debrided with a 4.0 full-radius resector as well.  The articular surfaces were well preserved.  The anterior and inferior labral structures were intact after debriding it.  However, there was a complete avulsion of the superior labrum of the superior glenoid extending posteriorly to approximately the 2 o'clock position.  Being careful with the location of neurovascular structures, the paralabral cyst was decompressed in its entirety with using 4.0 full-radius resector.  Next, the superior glenoid and labral structures were debrided with a 4.0 full-radius resector.  Next, two Smith & Nephew 2.9 mm BIORAPTOR anchors were implanted into the superior glenoid rim, one posterior to the biceps tendon at approximately the 1:30 position and the one anterior to the biceps tendon.  Each suture line was passed through healthy portions of labral tissue and then tied down using Slide-N-Lock followed by 2.5 inches.  The repair was (inaudible) and found to be stable.  The scope was placed in the anterior and superior portal viewing the posterior labral structures, which were intact after the end of the repair.  The scope was then placed in the subacromial position.  Diagnostic bursoscopy demonstrated normal rotator cuff tendon and the coracoacromial ligament was also intact without any fraying.  The arthroscopic equipment was removed from the joint.  Portals were then closed using 3-0 Vicryl buried interrupted sutures followed by Steri-Strips to the skin, 30 cc of 0.5% Marcaine plain was injected into the portal sites in the joint.  Sterile bulky dressing was placed on the shoulder.  The patient was then placed on a sling.  The patient was then extubated, transferred to the recovery room, then awakened, neurovascularly intact.  Sponge and needle counts were accurate.


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## Biller1325

Did you ever get an answer for your question? Need help with that too.


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## twosmek

Need help with this as well

Postop DX: Rt superior and posterior superior labral tear with large paralabral ganglion cyst causing compression of the suprascapular nerve and weakness in the infraspinatus muscle.
Procdure performed were: 
1. Right shoulder arthroscopy with decompression and posterior superior perilabra ganglion cyst
2. SLAP repair
3. Posterior Labral repair with capsular plication

Codes were the following
DX: 840.7 and 727.4
CPT: 29806, 29807, 29822

This is what he coded--I am not sold!!!


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## z009367

*Paralabral cyst decompression*

Did you ever hear back on what to use for paralabral cyst decompression when performed arthroscopically?  We are thinking possibly the debridement codes 29822/29823.


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## AlanPechacek

A "Paralabral Cyst" is basically an intra-articular Ganglion Cyst adjacent to the glenoid.  If it were treated by itself, i.e. as an isolated lesion, it would be by a limited/partial synovectomy (29820), as it is a synovial lesion.  If the arthroscopic shoulder procedure included the cyst treatment as a portion of a more extensive "debridement" of synovium, labrum, etc., then it would probably be an element of that "greater" procedure (29822, limited debridement, or 29823, extensive debridement) depending on how much of the joint was treated.  In that case, the treatment of the cyst would not warrant its own procedural code.

Hope this helps some.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com


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## christinnagle

Agree with AlanPechacek response per review with my surgeons.


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