# Open core decompression shoulder with arthroscopic revision rotator cuff repair



## Desperate Denise (Feb 15, 2010)

If anyone could help me please code this one?

For the revision of the rotator cuff repair arthroscopically - 29827-22 but then for the open core decompression I was thinking of using the unlisted code for open shoulder surgery.  

Thanks in advance guys - getting a lot of tough ones these days!!

 OPERATION PERFORMED:
 1.        Left shoulder arthroscopy.
 2.        Left shoulder revision rotator cuff repair - recurrent rotator cuff tear
 3.        Left shoulder core decompression - avascular necrosis humeral head

  The area of the previous  arthroscopic
 incision  was  marked posteriorly.  A mark was made 5  cm  down  from  the
 lateral  aspect  of  the acromion to insure that the  axillary  nerve  was
 protected  throughout the case and then the arthroscope was introduced  in
 the  posterior aspect of the glenohumeral joint and diagnostic arthroscopy
 was begun.  There was softening of the cartilage over the humeral head but
 no  evidence  of  frank  collapse.  There was no evidence  of  concomitant
 changes  on  the  glenoid surface.  Biceps tendon was in  good  condition.
 There  was  evidence of a high-grade partial thickness rotator  cuff  tear
 involving the supraspinatus tendon.  Infraspinatus tendon was intact.   No
 evidence  of  loose bodies within the axillary pouch.  An anterior  portal
 was  made  using an outside-in technique.  An 18 gauge spinal  needle  was
 inserted  above the superior border of the subscapularis  muscle.   An  11
 blade scalpel was used to incise the skin.  A 7-0 cannula from Arthrex was
 introduced  in  the  glenohumeral  joint.   The  humeral  head   articular
 cartilage  was probed.  It was felt to be stable.  An arthroscopic  shaver
 was placed on the rotator cuff tear for debridement interarticularly.   It
 was  marked with an 0 Prolene stitch.  Then the arthroscope was introduced
 in  the subacromial space.  A lateral portal was established approximately
 3 fingerbreadths down from the anterior lateral aspect of the acromion and
 a 7-0 cannula from Arthrex was introduced in the subacromial space.  There
 was   evidence  of  a  full-thickness  rotator  cuff  tear  with  previous
 arthroscopic  stitches.  The previous arthroscopic stitches were  removed.
 The  edges  of  the  rotator  cuff tear were debrided  using  arthroscopic
 shaver.   The greater tuberosity footprint was cleared of all soft tissues
 using  arthroscopic shaver as well as the ArthroCare wand and decorticated
 using  a  4-0  acromionizer bur.  An anterior portal was  established.   A
 single  side-to-side stitch was placed and then a single 5.5 Helix  anchor
 was  placed in the greater tuberosity footprint.  Each limb of  the  Helix
 anchor was passed through the rotator cuff tissue.  The stitches were tied
 in  a  sequential  fashion using ____________ x6.  Once the  rotator  cuff
 repair  was  complete, the core decompression of the case  was  performed.
 The  arm  was brought into slight abduction.  Using the 7-0 cannula,  this
 was brought down to the lateral aspect of the humerus.  Under fluoroscopic
 image  in  the AP plane, a guidewire for the biotenodesis kit was advanced
 under  fluoroscopic  image to the subchondral plate in  the  area  of  the
 avascular  necrosis area on MRI.  The position of the guidewire  was  then
 checked  in  the axillary view.  It was felt to be slightly posterior.   A
 second  Steinmann pin was placed just anterior to that in the same  plane.
 First  the Steinmann pin was removed.  Using the second Steinmann pin  and
 the  4 mm biotenodesis cannulated drill, drilling of the subchondral plate
 was performed using this 4.0 cannulated drill.  Gentle manipulation of the
 drill  both anterior and posterior was used to confirm that the  sclerotic
 area was fully decompressed.  Venous bleeding was seen through the cannula after  decompression.   Care was taken to preserve the  subchondral  plate which  was confirmed after decompression was complete.


----------



## BCrandall (Feb 16, 2010)

Yes the core decompression is an unlisted code, whether open or via scope.


----------



## LBROOKSHI (Feb 8, 2011)

May I ask, what compare code(s) did you use for the core decompression?


----------

