Provider performed open fixation of a posterior shoulder dislocation with fixation of a Lesser tuberosity fracture:
An oblique incision was made over the anterior aspect of the patient's left shoulder in a standard deltopectoral approach to the shoulder was performed. Identified the biceps tendon in the bicipital groove and after opening up the investing sheath the tendon was noted to be partially torn. Consequently I tenotomized the tendon to double border of the pectoralis major tendon and released it intra-articularly resecting the intervening section. After the biceps was resected/tenotomized I was able to identify and dissect out the lesser tuberosity fracture fragment. At this time I proceeded to gently manipulate the patient's glenohumeral joint reducing it from its locked posterior dislocation. The reverse Hill-Sachs lesion was fairly large and noted to have sclerotic bone. Consequently using a 4 oh burr I abraded the bone surface and the reverse Hill-Sachs lesion to a bleeding surface. The same was done for the lesser tuberosity fracture fragment. At this time to Arthrex 5.5 mm bio composite corkscrew anchors were inserted along the medial edge of the reverse Hill-Sachs lesion. The double loaded sutures from each anchor were passed through the bone tendon junction of the lesser tuberosity fracture fragment. The sutures were sequentially tied approximating the medial edge of the fracture fragment to the medial edge of the reverse Hill-Sachs lesion. I packed the reverse Hill-Sachs lesion with cancellus bone chips. The lesser tuberosity fracture fragment was closed down over this into the reverse Hill-Sachs lesion and held in place with a K wire. Using a cannulated 2.7 mm drill a pilot hole was drilled over the K wire. At this time a partially threaded 4.0 mm cannulated screw of appropriate length was inserted over the K wire compressing the lesser tuberosity fracture fragment into the reverse Hill-Sachs defect. Individual suture limbs from the to corkscrew anchors were draped over the lesser tuberosity fragment and threaded together into lateral proximal and distal 4.75 mm bio composite swivel lock anchors. This completed the fixation of the lesser tuberosity fracture fragment into the reverse Hill-Sachs defect. Intraoperative fluoroscopy was utilized to confirm appropriate reduction of the joint and fixation of the lesser tuberosity fracture fragment. The patient shoulder was thoroughly irrigated using copious amounts of sterile saline. layered closure of the incision was performed using 3-0 Vicryl for subcutaneous closure and 3-0 Prolene for running subcuticular closure. Sterile dressings were applied using Steri-Strips, 4 x 4 gauze, and Tegaderm. The patient was awoken, extubated, transferred to his bed, and wheeled to recovery in stable condition.
Provider dropped 23670, but this is for a Greater tuberosity fracture. Would this be coded as unlisted, 23929, with comparison to 23670?
Any help is appreciated.
An oblique incision was made over the anterior aspect of the patient's left shoulder in a standard deltopectoral approach to the shoulder was performed. Identified the biceps tendon in the bicipital groove and after opening up the investing sheath the tendon was noted to be partially torn. Consequently I tenotomized the tendon to double border of the pectoralis major tendon and released it intra-articularly resecting the intervening section. After the biceps was resected/tenotomized I was able to identify and dissect out the lesser tuberosity fracture fragment. At this time I proceeded to gently manipulate the patient's glenohumeral joint reducing it from its locked posterior dislocation. The reverse Hill-Sachs lesion was fairly large and noted to have sclerotic bone. Consequently using a 4 oh burr I abraded the bone surface and the reverse Hill-Sachs lesion to a bleeding surface. The same was done for the lesser tuberosity fracture fragment. At this time to Arthrex 5.5 mm bio composite corkscrew anchors were inserted along the medial edge of the reverse Hill-Sachs lesion. The double loaded sutures from each anchor were passed through the bone tendon junction of the lesser tuberosity fracture fragment. The sutures were sequentially tied approximating the medial edge of the fracture fragment to the medial edge of the reverse Hill-Sachs lesion. I packed the reverse Hill-Sachs lesion with cancellus bone chips. The lesser tuberosity fracture fragment was closed down over this into the reverse Hill-Sachs lesion and held in place with a K wire. Using a cannulated 2.7 mm drill a pilot hole was drilled over the K wire. At this time a partially threaded 4.0 mm cannulated screw of appropriate length was inserted over the K wire compressing the lesser tuberosity fracture fragment into the reverse Hill-Sachs defect. Individual suture limbs from the to corkscrew anchors were draped over the lesser tuberosity fragment and threaded together into lateral proximal and distal 4.75 mm bio composite swivel lock anchors. This completed the fixation of the lesser tuberosity fracture fragment into the reverse Hill-Sachs defect. Intraoperative fluoroscopy was utilized to confirm appropriate reduction of the joint and fixation of the lesser tuberosity fracture fragment. The patient shoulder was thoroughly irrigated using copious amounts of sterile saline. layered closure of the incision was performed using 3-0 Vicryl for subcutaneous closure and 3-0 Prolene for running subcuticular closure. Sterile dressings were applied using Steri-Strips, 4 x 4 gauze, and Tegaderm. The patient was awoken, extubated, transferred to his bed, and wheeled to recovery in stable condition.
Provider dropped 23670, but this is for a Greater tuberosity fracture. Would this be coded as unlisted, 23929, with comparison to 23670?
Any help is appreciated.