Core Decompression
Unfortunately, I am not able to give you the correct code for this in the Humerus because there is no code, and the Unlisted code would be the best. Core Decompression is a procedure done by Orthopedic Surgeons for the treatment of early Avascular Necrosis of Bone, called Osteonecrosis in ICD-10. Most commonly this is done for the femoral head AVN, which is the most common site for this disorder, and is an attempt to save/preserve the femoral head for as long as possible since it is a weight bearing bone as well. It is done in the OR under anesthesia and with fluoroscopic guidance. Multiple drill hole are made through the neck up into the diseased/affected area of the femoral head. The hope is to restore circulation (revascularize) to the affected area of dead (devascularized) bone in hopes that it will "heal" and survive and thereby deferring the usual treatment of hip replacement. This disorder usually occurs in a younger age group of patients so trying to put off hip replacement as long as possible is worth the effort. This procedure has been around for several years, but I can't find a CPT code for it in the hip either, even in the Radiology codes for procedures done under fluoroscopic guidance.
As for the proximal humerus/head, this disorder can occur here as well, but is far less frequent than in the hip, so this procedure would be rarely done. Without the Operative Report to review, I am hard put to help. As for the arthroscopic aspect of this patient's shoulder surgery, about all the arthroscope would tell the surgeon is whether he did or did not penetrate the articular surface, which he doesn't want to do as it would damage that. I would reasonably expect that to have done a real "Core Decompression of the Proximal Humerus" he would have had to do it with fluoroscopic guidance as that is the only way to see if the drill has entered into the diseased area of the head. You can't see that through the arthroscope. I hope he put AVN (Osteonecrosis) of the Humeral Head in his pre and postoperative diagnoses list, otherwise he could not charge for it even if there was a CPT code. If you could find a CPT Code for this in the hip/femoral head, then you could "pair" it with that.
Unfortunately, mu response only gives you some education, but doesn't help you find the right code. I wish I could help you more.
Respectfully submitted, Alan Pechacek, M.D.
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