Desperate Denise
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Hey guys - another quick question.
I am constantly in discussions (lets call it that) with the physicians about arthroscopic subacromial decompression and labral debridements performed with mini-open rotator cuff tears.
I have taught that with open rotator cuff repairs (23412) the 29826 would be included in the open procedure. The 29822 in this scenario appears to be bundled with 29826.
If you could please comment on this opnote and assist me with obtaining any literature to present to the physicians at my next meeting it would be so overwhelmingly appreciated.
POSTOPERATIVE DIAGNOSIS: Left shoulder massive rotator cuff tear,
impingement syndrome, labral tear.
OPERATION PERFORMED: Left shoulder arthroscopy.
Arthroscopic labral debridement of type 1 tear.
Arthroscopic subacromial decompression.
Mini open repair of massive rotator cuff tear.
and placed supine on the operating room table. After induction of general
anesthetic, she was placed in a beach chair position. All bony
prominences were padded. A posterior portal was created. Examination of
the shoulder showed normal glenohumeral articular surfaces. There was
fraying of the superior aspect of the subscapularis tendon. The biceps
tendon was absent intraarticularly. There was a tear extending from the
top of the subscapularis down to the infraspinatus. The tear was a
crescent-shaped tear and had delamination component to it. The labrum had
a type 1 tear right at the biceps attachment which was debrided with a 4.5
mm full-radius shaver. Attention was directed to the subacromial space
where a type 3 acromion was visualized and acromioplasty was performed. A
mini open rotator cuff tear was carried out with dissection down through
skin and deltoid fascia. The superior leaf was debrided. The greater
tuberosity was debrided with a 5.0 bur. There was blood coming from the
greater tuberosity. The tendon edges were debrided and a traction suture
was placed. The traction suture showed there was a crescent-shaped tear.
No need for convergence sutures. The 5.5 PEEK anchor was placed
posteriorly. An attempt at a 5.5 PEEK anchor was placed in the mid
tuberosity and it pulled out. A 6.5 anchor also pulled out. A 5.5 anchor
PEEK anchor was then placed anterior to the weak tuberosity bone. The 4
sutures were placed in a horizontal mattress fashion. These were then
tied down, and two 4.5 suture lock anchors were placed laterally inferior
to the greater tuberosity. The tendon edges were brought down nicely and
covering the footprint of the greater tuberosity. There was no tension on
the repair. The arm could be placed at the side comfortably. The
shoulder was irrigated. The deltoid fascia was closed with 0 Vicryl
suture, 2-0 Vicryl in the subcutaneous tissue, 4-0 Monocryl in the skin. Steri-Strips and dry sterile dressing...
I am constantly in discussions (lets call it that) with the physicians about arthroscopic subacromial decompression and labral debridements performed with mini-open rotator cuff tears.
I have taught that with open rotator cuff repairs (23412) the 29826 would be included in the open procedure. The 29822 in this scenario appears to be bundled with 29826.
If you could please comment on this opnote and assist me with obtaining any literature to present to the physicians at my next meeting it would be so overwhelmingly appreciated.
POSTOPERATIVE DIAGNOSIS: Left shoulder massive rotator cuff tear,
impingement syndrome, labral tear.
OPERATION PERFORMED: Left shoulder arthroscopy.
Arthroscopic labral debridement of type 1 tear.
Arthroscopic subacromial decompression.
Mini open repair of massive rotator cuff tear.
and placed supine on the operating room table. After induction of general
anesthetic, she was placed in a beach chair position. All bony
prominences were padded. A posterior portal was created. Examination of
the shoulder showed normal glenohumeral articular surfaces. There was
fraying of the superior aspect of the subscapularis tendon. The biceps
tendon was absent intraarticularly. There was a tear extending from the
top of the subscapularis down to the infraspinatus. The tear was a
crescent-shaped tear and had delamination component to it. The labrum had
a type 1 tear right at the biceps attachment which was debrided with a 4.5
mm full-radius shaver. Attention was directed to the subacromial space
where a type 3 acromion was visualized and acromioplasty was performed. A
mini open rotator cuff tear was carried out with dissection down through
skin and deltoid fascia. The superior leaf was debrided. The greater
tuberosity was debrided with a 5.0 bur. There was blood coming from the
greater tuberosity. The tendon edges were debrided and a traction suture
was placed. The traction suture showed there was a crescent-shaped tear.
No need for convergence sutures. The 5.5 PEEK anchor was placed
posteriorly. An attempt at a 5.5 PEEK anchor was placed in the mid
tuberosity and it pulled out. A 6.5 anchor also pulled out. A 5.5 anchor
PEEK anchor was then placed anterior to the weak tuberosity bone. The 4
sutures were placed in a horizontal mattress fashion. These were then
tied down, and two 4.5 suture lock anchors were placed laterally inferior
to the greater tuberosity. The tendon edges were brought down nicely and
covering the footprint of the greater tuberosity. There was no tension on
the repair. The arm could be placed at the side comfortably. The
shoulder was irrigated. The deltoid fascia was closed with 0 Vicryl
suture, 2-0 Vicryl in the subcutaneous tissue, 4-0 Monocryl in the skin. Steri-Strips and dry sterile dressing...
