# trephination calcific tendonitis



## spebuck (Aug 17, 2012)

This is a new one for me. The doc states in the note that he performed a trephination of the calcific masses using a needle. Normally, I would use cpt 23000, however, this was not an open procedure. Is there anything else that I could use rather than 20610? 
The note is below:

PARQ discussion was held. Supraspinatous was visualized and areas of calcific tendinitis were noted.  There is edema and fluid collected in the subacromial subdeltoid bursa.  I determined  appropriate trajectory into the calcification.  The skin was marked, prepped, and draped in a sterile fashion, and anesthetized with buffered lidocaine.  Sterile probe cover and sterile ultrasound gel was utilized.  A 25-gauge, 2-inch spinal needle was introduced and directed incrementally into calcification with direct visualization with ultrasound.  I numbed up this area and the tract with 1% lidocaine.  I then introduced an 22-gauge needle and trephinated each calcification with multiple passes.  With negative aspiration no calcium was aspirated. Then injected 2 mL of  2% lidocaine, 2 mL of 0.25% Marcaine and 1 mL of Kenalog (40 mg), with 10 mg of dexamethasone.  Primarily into the subacromial bursa as well as a small amount around the trephinated areas.  This was well tolerated by the patient.  The needle was removed and a band-aid was applied to the injection site.  The patient noted no pain at time of discharge, and was observed for an additional 10 minutes.  The patient left in good condition.

Thanks for your help


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## MMCC88 (Feb 6, 2019)

I'd love to know the answer to this too!


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## iowagirl77 (Feb 7, 2019)

We debated this as well. The work done seems more extensive than 20610, but 23000 is for open procedure so that didn't seem appropriate either. We settled on an unlisted code with 23000 or 27306 as the comparison.


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