talitha82
Guest
I am struggling with a hip arthro case. This patient had both a gluteus minimus repair and an arthroscopic trochanteric bursectomy. I understand that the tendon repair is an unlisted code, but it seems the bursectomy is also going to be unlisted (done arthroscopically)- can I bill two unlisted codes together? And if so, I cannot seem to find an appropriate code comparison for pricing on either of these. Any thoughts?
PREOPERATIVE DIAGNOSIS: Left hip gluteus minimus tendon tear with trochanteric
bursitis.
POSTOPERATIVE DIAGNOSIS: Left hip gluteus minimus tendon tear with trochanteric
bursitis.
PROCEDURES PERFORMED:
1. Left hip endoscopic gluteus minimus tendon repair.
2. Endoscopic trochanteric bursectomy.
INDICATIONS FOR PROCEDURE: Patient presented with
chronic lateral left hip pain. Physical exam and MRI were consistent with the above
diagnosis. She was initially managed with a trochanteric cortisone injection and
physical therapy. Unfortunately, she failed nonoperative management, and with
persistent pain and disability she was very limited in terms of her ability to walk
long distances. We had a long discussion regarding treatment options. The patient
elected to proceed with surgical intervention, thus she is taken to the operating
room.
OPERATIVE PROCEDURE: After obtaining informed consent and identification of
appropriate left hip, the patient was taken to the operating room and placed under
general anesthetic. She was placed on the Hanna table. The left hip was prepped and
draped in the standard, sterile fashion. Preoperative antibiotics were given, and an
appropriate surgical timeout was performed. Fluoroscopy was used to determine
appropriate starting points for the surgery.
A standard mid anterior portal was 1st utilized to place the arthroscope into the
space between the iliotibial band and the greater trochanter. We then placed a 2nd
portal distal to the standard anterolateral portal by 5 cm. We placed a shaver in
the greater trochanteric space and debrided the bursa. We identified the gluteal
sling, which is the insertion of the gluteus maximus, as well as the vastus
lateralis. We then moved more proximally and debrided the trochanteric bursa in this
space.
Patient had a near full-thickness tear of the gluteus minimus. This was unroofed to
reveal the undersurface tear. This area was gently debrided. A bur was used to
prepare the greater tuberosity. We then placed 2 corkscrew anchors in the anterior
facet of the greater trochanter. Fluoroscopy was used to confirm appropriate
trajectory. We then repaired the gluteus minimus tendon back to the anterior facet
using a combination of horizontal mattress and simple sutures. We then removed the
equipment from the hip. The hip was drained. The portals were closed with 3-0
Monocryl and 3-0 nylon. She was dressed with Xeroform gauze, sterile 4 x 4s, ABDs,
and tape. She was placed in a hinged range of motion brace. She was then extubated,
moved to the gurney, and taken to the PACU in stable condition. Instrument, needle
and sponge counts were correct at the end of the case.
PREOPERATIVE DIAGNOSIS: Left hip gluteus minimus tendon tear with trochanteric
bursitis.
POSTOPERATIVE DIAGNOSIS: Left hip gluteus minimus tendon tear with trochanteric
bursitis.
PROCEDURES PERFORMED:
1. Left hip endoscopic gluteus minimus tendon repair.
2. Endoscopic trochanteric bursectomy.
INDICATIONS FOR PROCEDURE: Patient presented with
chronic lateral left hip pain. Physical exam and MRI were consistent with the above
diagnosis. She was initially managed with a trochanteric cortisone injection and
physical therapy. Unfortunately, she failed nonoperative management, and with
persistent pain and disability she was very limited in terms of her ability to walk
long distances. We had a long discussion regarding treatment options. The patient
elected to proceed with surgical intervention, thus she is taken to the operating
room.
OPERATIVE PROCEDURE: After obtaining informed consent and identification of
appropriate left hip, the patient was taken to the operating room and placed under
general anesthetic. She was placed on the Hanna table. The left hip was prepped and
draped in the standard, sterile fashion. Preoperative antibiotics were given, and an
appropriate surgical timeout was performed. Fluoroscopy was used to determine
appropriate starting points for the surgery.
A standard mid anterior portal was 1st utilized to place the arthroscope into the
space between the iliotibial band and the greater trochanter. We then placed a 2nd
portal distal to the standard anterolateral portal by 5 cm. We placed a shaver in
the greater trochanteric space and debrided the bursa. We identified the gluteal
sling, which is the insertion of the gluteus maximus, as well as the vastus
lateralis. We then moved more proximally and debrided the trochanteric bursa in this
space.
Patient had a near full-thickness tear of the gluteus minimus. This was unroofed to
reveal the undersurface tear. This area was gently debrided. A bur was used to
prepare the greater tuberosity. We then placed 2 corkscrew anchors in the anterior
facet of the greater trochanter. Fluoroscopy was used to confirm appropriate
trajectory. We then repaired the gluteus minimus tendon back to the anterior facet
using a combination of horizontal mattress and simple sutures. We then removed the
equipment from the hip. The hip was drained. The portals were closed with 3-0
Monocryl and 3-0 nylon. She was dressed with Xeroform gauze, sterile 4 x 4s, ABDs,
and tape. She was placed in a hinged range of motion brace. She was then extubated,
moved to the gurney, and taken to the PACU in stable condition. Instrument, needle
and sponge counts were correct at the end of the case.