j-fowler57
Guest
- Messages
- 136
- Best answers
- 0
Any help on this is appreciated . Thanks in advance Happy Thanksgiving!
I keep coming up with an addon code but know it is wrong. I just can't seem to get this code for the following:
POSTOPERATIVE DIAGNOSIS: Subcoracoid impingement syndrome, right shoulder.
TITLE OF PROCEDURE:
1. Surgical arthroscopy, right shoulder.
2. Assessment of all intraarticular structures, right shoulder.
3. Subcoracoid decompression, right shoulder.
ANESTHESIA: Scalene block plus general inhalation.
BRIEF HISTORY: The above-mentioned patient is a 28-year-old female with symptoms referable to the right shoulder, having persistent pain in the shoulder, particularly anteriorly, refractory to standard conservative measures. Workup has included MRI scan, suggesting subcoracoid impingement. Admitted now for surgery to decompress the area in question.
FINDINGS AT SURGERY: Findings at surgery revealed an area of superficial injury to the subscapularis medial to the “comma” sign and evidence of impingement from the inferior aspect of the coracoid process.
DETAILED OPERATIVE PROCEDURE: After the induction of satisfactory general inhalation anesthesia, the patient was placed in the Schlein-type chair positioner and was placed in the beach chair position. All bony prominences were padded and protected. The blood pressure was checked, and she remained stable. The right upper extremity was then prepped and draped in standard fashion. A marking pen was used to mark all bony landmarks, and 0.25% Marcaine with epinephrine was placed posterior, lateral, anterior to the acromion. We anticipated a posterior portal as well as an anterior superolateral portal.
A posterior portal was developed, and a 30-degree arthroscope was placed into the glenohumeral joint. We examined the contents of the glenohumeral joint. The labrum was intact in its entirety. There was no SLAP tear. The biceps tendon showed mild tendonitis. I saw no impingement laterally along this area. I examined the posterior glenoid. It was intact. No loose bodies were encountered. There was synovitis anteriorly. There was no significant scarring of the rotator interval.
Using the anterior superolateral portal, I placed a spinal needle into the joint and assessed this area. I placed a probe and was able to probe that the coracoid process scapula anteriorly was actually extended inferior to the level of the subscapularis tendon and was curved laterally slightly. In addition, there was no direct apposition of the coracoid process of the scapula to the subscapularis tendon in neutral position. However, when I externally rotated and abducted the arm, I suspected the area of shininess and loss of covering of the tendon sheath medial to the “comma” sign was significant. I probed the subscapularis and did not find a specific tear in the subscapularis.
Based upon the findings above, I introduced the radiocautery and began to deskeletonize and decorticate the inferior aspect of the coracoid process. My desire was to at least open this up at least 7 mm, and we were successful by using the oval bur, the barrel-type bur, to decompress the inferior aspect of the coracoid process, obtaining hemostasis with radiocautery. The proved to be successful.
As we decompressed this area, we then tested the shoulder, and it appeared that we had opened up the area sufficiently well. No further approach of the coracoid area to the subscapularis occurred.
I keep coming up with an addon code but know it is wrong. I just can't seem to get this code for the following:
POSTOPERATIVE DIAGNOSIS: Subcoracoid impingement syndrome, right shoulder.
TITLE OF PROCEDURE:
1. Surgical arthroscopy, right shoulder.
2. Assessment of all intraarticular structures, right shoulder.
3. Subcoracoid decompression, right shoulder.
ANESTHESIA: Scalene block plus general inhalation.
BRIEF HISTORY: The above-mentioned patient is a 28-year-old female with symptoms referable to the right shoulder, having persistent pain in the shoulder, particularly anteriorly, refractory to standard conservative measures. Workup has included MRI scan, suggesting subcoracoid impingement. Admitted now for surgery to decompress the area in question.
FINDINGS AT SURGERY: Findings at surgery revealed an area of superficial injury to the subscapularis medial to the “comma” sign and evidence of impingement from the inferior aspect of the coracoid process.
DETAILED OPERATIVE PROCEDURE: After the induction of satisfactory general inhalation anesthesia, the patient was placed in the Schlein-type chair positioner and was placed in the beach chair position. All bony prominences were padded and protected. The blood pressure was checked, and she remained stable. The right upper extremity was then prepped and draped in standard fashion. A marking pen was used to mark all bony landmarks, and 0.25% Marcaine with epinephrine was placed posterior, lateral, anterior to the acromion. We anticipated a posterior portal as well as an anterior superolateral portal.
A posterior portal was developed, and a 30-degree arthroscope was placed into the glenohumeral joint. We examined the contents of the glenohumeral joint. The labrum was intact in its entirety. There was no SLAP tear. The biceps tendon showed mild tendonitis. I saw no impingement laterally along this area. I examined the posterior glenoid. It was intact. No loose bodies were encountered. There was synovitis anteriorly. There was no significant scarring of the rotator interval.
Using the anterior superolateral portal, I placed a spinal needle into the joint and assessed this area. I placed a probe and was able to probe that the coracoid process scapula anteriorly was actually extended inferior to the level of the subscapularis tendon and was curved laterally slightly. In addition, there was no direct apposition of the coracoid process of the scapula to the subscapularis tendon in neutral position. However, when I externally rotated and abducted the arm, I suspected the area of shininess and loss of covering of the tendon sheath medial to the “comma” sign was significant. I probed the subscapularis and did not find a specific tear in the subscapularis.
Based upon the findings above, I introduced the radiocautery and began to deskeletonize and decorticate the inferior aspect of the coracoid process. My desire was to at least open this up at least 7 mm, and we were successful by using the oval bur, the barrel-type bur, to decompress the inferior aspect of the coracoid process, obtaining hemostasis with radiocautery. The proved to be successful.
As we decompressed this area, we then tested the shoulder, and it appeared that we had opened up the area sufficiently well. No further approach of the coracoid area to the subscapularis occurred.