cclarson
Guru
I'm not sure how I should code the calcific tendinitis excision? I've been looking at possibly 23000? Also, would the open rotator cuff repair bundle in, I know it's 23412, but does the documentation support a RTC repair? Let me know what you think! 
Thank you!
POSTOPERATIVE DIAGNOSES:
1. Right shoulder calcific tendinitis.
2. Right shoulder subacromial impingement.
PROCEDURES PERFORMED:
1. Right shoulder open calcific tendinitis excision.
2. Right shoulder open rotator cuff repair.
INDICATIONS FOR PROCEDURE:
The patient is a 55-year-old female who I have been treating for calcific tendinitis in her right shoulder. She has failed conservative treatment including steroid injection, physical therapy, and modification of activities. We discussed surgical treatment options. I recommended open excision, actually given her small size and discussed that we would remove her calcification in her tendon and then repair whatever defect in the rotator cuff we created to remove this calcification. The risks, benefits, and alternatives were discussed with the patient, including risks of bleeding, infection, failure of any repairs, continued shoulder pain and dysfunction, and possible need for more surgery. The patient understood these risks and agreed to proceed.
DESCRIPTION OF PROCEDURE:
The patient was identified and marked in the preoperative area. Her H&P and consent form were signed and updated. She was taken to the operating room and intubated without complication. She did have a regional block placed by the anesthesia service without complication. She was placed in the beach chair position.
Her right upper extremity was prepped and draped in the normal sterile fashion. Preoperative antibiotics were given.
After surgical timeout was performed, we started with an incision about the anterolateral aspect of the acromion about 3 to 4 cm in length. We dissected down through the skin and subcutaneous tissues with knife and Bovie electrocautery, identified the plane over the deltoid fascia. This was then incised in the raphe between the anterior and middle thirds of the deltoid. This was split with Bovie cautery to minimize bleeding and identified her subacromial bursa which was excised. It was mild to moderately inflamed. She did not have any large subacromial spurs that felt needed to be removed. I then palpated the rotator cuff. I identified the thickening of her cuff in the area of her calcification. I incised over this with a knife. I expected the material to be a little bit harder that would be shelled out, but it was really more of a hard chalky type of material. So, we removed it with the Freer, the rongeur, and curet to sharply excise it. There were a few fragments left within the substance of the tendon itself. I took a couple of fluoroscopic images sequentially to document our debridement. When I thought we had good debridement both radiographically and clinically, we went ahead and stopped. We thoroughly irrigated out with saline solution and placed some FiberWire sutures in the cuff to repair it with some figure-of-eight sutures.
We then thoroughly irrigated it out again, the subacromial space, and closed the deltoid fascia with 2-0 Vicryl suture, the subcuticular layer with 2-0 Vicryl suture, and the skin with running nylon. Sterile dressings were applied. The patient’s arm was placed in a sling. She was awakened from anesthesia and taken to the recovery area in stable condition.
Thank you!POSTOPERATIVE DIAGNOSES:
1. Right shoulder calcific tendinitis.
2. Right shoulder subacromial impingement.
PROCEDURES PERFORMED:
1. Right shoulder open calcific tendinitis excision.
2. Right shoulder open rotator cuff repair.
INDICATIONS FOR PROCEDURE:
The patient is a 55-year-old female who I have been treating for calcific tendinitis in her right shoulder. She has failed conservative treatment including steroid injection, physical therapy, and modification of activities. We discussed surgical treatment options. I recommended open excision, actually given her small size and discussed that we would remove her calcification in her tendon and then repair whatever defect in the rotator cuff we created to remove this calcification. The risks, benefits, and alternatives were discussed with the patient, including risks of bleeding, infection, failure of any repairs, continued shoulder pain and dysfunction, and possible need for more surgery. The patient understood these risks and agreed to proceed.
DESCRIPTION OF PROCEDURE:
The patient was identified and marked in the preoperative area. Her H&P and consent form were signed and updated. She was taken to the operating room and intubated without complication. She did have a regional block placed by the anesthesia service without complication. She was placed in the beach chair position.
Her right upper extremity was prepped and draped in the normal sterile fashion. Preoperative antibiotics were given.
After surgical timeout was performed, we started with an incision about the anterolateral aspect of the acromion about 3 to 4 cm in length. We dissected down through the skin and subcutaneous tissues with knife and Bovie electrocautery, identified the plane over the deltoid fascia. This was then incised in the raphe between the anterior and middle thirds of the deltoid. This was split with Bovie cautery to minimize bleeding and identified her subacromial bursa which was excised. It was mild to moderately inflamed. She did not have any large subacromial spurs that felt needed to be removed. I then palpated the rotator cuff. I identified the thickening of her cuff in the area of her calcification. I incised over this with a knife. I expected the material to be a little bit harder that would be shelled out, but it was really more of a hard chalky type of material. So, we removed it with the Freer, the rongeur, and curet to sharply excise it. There were a few fragments left within the substance of the tendon itself. I took a couple of fluoroscopic images sequentially to document our debridement. When I thought we had good debridement both radiographically and clinically, we went ahead and stopped. We thoroughly irrigated out with saline solution and placed some FiberWire sutures in the cuff to repair it with some figure-of-eight sutures.
We then thoroughly irrigated it out again, the subacromial space, and closed the deltoid fascia with 2-0 Vicryl suture, the subcuticular layer with 2-0 Vicryl suture, and the skin with running nylon. Sterile dressings were applied. The patient’s arm was placed in a sling. She was awakened from anesthesia and taken to the recovery area in stable condition.