betsycpcp
Networker
Should the biceps tenodesis (23430) be reported with this ORIF of fractured proximal humerus (23615)? There is no NCCI edit, but I have seen a couple of comments in coding forums stating it would not be separately billed but I'm not sure. One thing that is throwing me off is it looks like a word or two could be missing - "we identified that the biceps tendon and proceeded to perform a bicipital tenodesis..." Not sure what they identified about about the tendon. In any case, I'm hoping someone is familiar with this type of repair - would the biceps tenodesis just be part of the fracture repair or should it be reported? There is no biceps diagnosis- the pre- and post-op dx is just the 4 part displaced proximal humerus fracture.
"We then proceeded to mark the landmarks laterally and made a linear incision slightly lateral to the coracoid and extending to the deltoid attachment distally. Once through the skin and cutaneous tissues were dissected sharply down to the deltopectoral interval. We then identified the cephalic vein and attempted to move this medially. Bleeding did occur and this did have to be tied off with 0 silk sutures. Once the deltopectoral interval was entered we identified the lateral edge of the conjoined tendon and incised the clavipectoral fascia proximally and distally. We were then able to place a self retaining retractor into this interval for better visualization. We easily identified the shaft fracture as this was sitting directly behind the conjoined tendon. Once this plane was developed we identified that the biceps tendon and proceeded to perform a bicipital tenodesis to the intact pectoralis major insertion. We resected the remainder of the tendon and then placed traction sutures through the subscapularis muscle and around the lesser tuberosity fragment as well as posteriorly around the greater tuberosity fragment. We incised the upper 25% of the pectoralis major insertion and then receded to clean soft tissue out of the fracture site. Once this was cleaned we then manually reduce to fracture and verified this on AP fluoroscopy. We then were able to shift the humeral head in the position and with distal traction were able to achieve reasonable reduction we then selected a short Zimmer high proximal humerus plate f and placed this anterior laterally over the humerus just lateral to the pectoralis major insertion and just posterior to the bicipital groove. Once this was complete and held into position with threaded K wires AP and lateral images were obtained to ensure good reduction. Once this was confirmed, we proceeded to place a single standard 3 5 cortical screw using AO technicque distally in the oblong hole. Once this was adhered to the distal shaft, the proximalmost locking screw was then placed using standard AO technique. We then removed the K wires confirmed reduction on AP and scapular Y and then proceeded to place an additional 4 locking screws proximally. We then placed an additional 2 screws distally the second from the most distal hole was placed locking and the distalmost hole was placed nonlocking. Once this was complete final AP and lateral images were obtained. We copiously irrigated the incision site and reapproximated the skin with 2-0 Vicryl and staples."
"We then proceeded to mark the landmarks laterally and made a linear incision slightly lateral to the coracoid and extending to the deltoid attachment distally. Once through the skin and cutaneous tissues were dissected sharply down to the deltopectoral interval. We then identified the cephalic vein and attempted to move this medially. Bleeding did occur and this did have to be tied off with 0 silk sutures. Once the deltopectoral interval was entered we identified the lateral edge of the conjoined tendon and incised the clavipectoral fascia proximally and distally. We were then able to place a self retaining retractor into this interval for better visualization. We easily identified the shaft fracture as this was sitting directly behind the conjoined tendon. Once this plane was developed we identified that the biceps tendon and proceeded to perform a bicipital tenodesis to the intact pectoralis major insertion. We resected the remainder of the tendon and then placed traction sutures through the subscapularis muscle and around the lesser tuberosity fragment as well as posteriorly around the greater tuberosity fragment. We incised the upper 25% of the pectoralis major insertion and then receded to clean soft tissue out of the fracture site. Once this was cleaned we then manually reduce to fracture and verified this on AP fluoroscopy. We then were able to shift the humeral head in the position and with distal traction were able to achieve reasonable reduction we then selected a short Zimmer high proximal humerus plate f and placed this anterior laterally over the humerus just lateral to the pectoralis major insertion and just posterior to the bicipital groove. Once this was complete and held into position with threaded K wires AP and lateral images were obtained to ensure good reduction. Once this was confirmed, we proceeded to place a single standard 3 5 cortical screw using AO technicque distally in the oblong hole. Once this was adhered to the distal shaft, the proximalmost locking screw was then placed using standard AO technique. We then removed the K wires confirmed reduction on AP and scapular Y and then proceeded to place an additional 4 locking screws proximally. We then placed an additional 2 screws distally the second from the most distal hole was placed locking and the distalmost hole was placed nonlocking. Once this was complete final AP and lateral images were obtained. We copiously irrigated the incision site and reapproximated the skin with 2-0 Vicryl and staples."
